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1

Quantitative evaluation after arthroscopic anterior cruciate ligament reconstructionAllograft versus autograft  

Microsoft Academic Search

We measured the anteroposterior ligamentous laxity and thigh muscle power in 92 subjects who were rated as successes after they had undergone arthroscopic anterior cruciate ligament reconstruction for unilateral anterior cruciate ligament insufficiency 18 to 36 months previously. The subjects were divided into 2 groups according to the type of graft: fresh-frozen allogenic tendon (N = 47) or central one

Konsei Shino; Ken Nakata; Shuji Horibe; Masahiro Inoue; Shigeto Nakagawa

1993-01-01

2

A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction  

Microsoft Academic Search

We performed a comparative study of two series of 25 patellar tendon arthroscopic reconstructions of isolated chronic anterior cruciate ligament injuries, alternating between a double-incision (using a rear-entry guide) or single-incision technique (using a transtibial approach). The patients were reviewed to assess the clinical, KT-2000 and radiological differences at an average follow-up of 14 months (range 8–18 months). For the

P. Aglietti; G. Zaccherotti; P. P. M. Menchetti; P. De Biase

1995-01-01

3

Anatomic Anterior Cruciate Ligament Reconstruction With a Flexible Reamer System and 70? Arthroscope  

PubMed Central

Anterior cruciate ligament (ACL) reconstruction techniques continue to evolve as surgeons seek to improve surgical process and outcome measures. On the basis of published data showing improved biomechanics, many surgeons now attempt to better re-create native ACL anatomy in reconstruction. Use of flexible reamer technology and a 70° arthroscope allows for excellent visualization of the native ACL anatomy, as well as precise and independent drilling of the tibial and femoral reconstruction tunnels, while offering several surgical and technical advantages compared with other drilling techniques. This technical note with accompanying video describes our use of the Smith & Nephew Clancy anatomic cruciate guide/flexible drill system (Smith & Nephew, London, England) with a 70° arthroscope. PMID:24400174

Rasmussen, Jeffrey F.; Lavery, Kyle P.; Dhawan, Aman

2013-01-01

4

Massive Bone Loss from Fungal Infection after Anterior Cruciate Ligament Arthroscopic Reconstruction  

PubMed Central

Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Electronic supplementary material The online version of this article (doi:10.1007/s11999-009-0714-0) contains supplementary material, which is available to authorized users. PMID:19190972

Carbo, Lisandro; Aponte-Tinao, Luis A.; Ayerza, Miguel A.; Makino, Arturo

2009-01-01

5

Arthrometric stability of horizontal versus vertical single-bundle arthroscopic anterior cruciate ligament reconstruction.  

PubMed

The anteroposterior (AP) stability of standard anterior cruciate ligament (ACL) reconstruction, referred to as "vertical," was compared with that of a modified femoral position, referred to as "horizontal," which is lower than and anterior to an operative knee at 90° flexion. Two consecutive series of 50 patients underwent vertical and horizontal arthroscopic single-bundle ACL reconstruction, respectively. For vertical reconstruction, the clock position was chosen, placing the graft at 10:30 in right knees and 1:30 in left knees, 1 to 2 mm anterior to the posterior femoral cortical cortex and at the back of the resident ridge. In the horizontal reconstruction, the transplant replaced the original ligament insertion at approximately the 9:30 o'clock position in right knees and the 2:30 o'clock position in left knees, approximately 2 mm in front of the posterior femoral cortical cortex. One year after surgery, the results of stabilometric evaluation revealed good performance after horizontal transplant. The mean clinical results changed from 1.0 (±1.3) mm for vertical to 0.7 (±1.3) mm for horizontal reconstruction. PMID:24810813

Denti, Matteo; Arrigoni, Paolo; Volpi, Piero; Bait, Corrado; Sedran, Jean Claude; Randelli, Pietro

2014-05-01

6

[Arthroscopic reconstruction of the anterior cruciate ligament using double anteromedial and posterolateral bundles].  

PubMed

We propose a method for repairing the anterior cruciate ligament which takes advantage of the multifascular nature of the ligament to achieve better physiological anteroposterior and rotational stability compared with conventional methods. Arthroscopic reconstruction of the anteromedial and posterolateral bundles of the ligament closely reproduces normal anatomy. We have used this technique in 92 patients with anterior cruciate ligament laxity and present here the mid-term results. The hamstring tendons (gracilis and semitendinosus) are harvested carefully to obtain good quality grafts. Arthroscopic preparation of the notch allows careful cleaning of the axial aspect of the lateral condyle; it is crucial to well visualize the region over the top and delimit the 9 h-12 h zone for the right knee or the 12-15 h zone for the left knee. The femoral end of the anteromedial tunnel lies close to the floor of the intercondylar notch, 5 to 10 mm in front of the posterior border of the lateral condyle, at 13 h for the left knee and 11 h for the right knee. The femoral end of the posterolateral tunnel lies more anteriorly, at 14 h for the left knee and 10 h for the right knee. The tibial end of the posterolateral tunnel faces the anterolateral spike of the tibia. The tibial end of the anteromedial tunnel lies in front of the apex of the two tibial spikes half way between the anteromedial spike and the anterolateral spike, 8 mm in front of the protrusion of the posteriolateral pin. The posterolateral graft is run through the femoral and tibial tunnels first. A cortical fixation is used for the femoral end. The femoral end of the anteromedial graft is then fixed in the same way. The tibial fixation begins with the posterolateral graft with the knee close to full extension. The anteromedial graft is fixed with the knee in 90 degrees flexion. Thirty patients were reviewed at least six months after the procedure. Mean age was 28.2 years. Mean overall IKDC score was 86% (36% A and 50% B). Gain in laxity was significant: 6.53 preoperatively and 2.1 postoperatively. Most of the patients (86.6%) were able to resume their former occupation 2 months after the procedure. The different components of the anterior cruciate ligament and their respective functions have been the object of several studies. The anteromedial bundle maintains joint stability during extension and anteroposterior stability during flexion. The posterolateral bundle contributes to the action of the anteromedial bundle with an additional effect due to its position: rotational stability during flexion. In light of the multifascicular nature of the anterior cruciate ligament and the residual rotational laxity observed after conventional repair, our proposed method provides a more anatomic reconstruction which achieves better correction of anteroposterior and rotational stability. This technique should be validated with comparative trials against currently employed methods. PMID:12457115

Franceschi, J P; Sbihi, A; Champsaur, P

2002-11-01

7

Functional Outcome in Athletes at Five Years of Arthroscopic Anterior Cruciate Ligament Reconstruction  

PubMed Central

Introduction. The purpose of this study was to analyze the functional outcome in competitive level athletes at 5 years after ACL reconstruction with regard to return to sports and the factors or reasons in those who either stopped sports or showed a fall in their sporting levels. Methods. 48 competitive athletes who had undergone arthroscopic assisted ACL reconstruction with a minimum follow up of at least 5 years were successfully recalled and were analyzed. Results. 22 patients had returned to the preinjury levels of sports and 18 showed a decrease in their sporting levels. Of the 18 patients, 12 referred to fear of reinjuring the same or contra-lateral knee as the prime reason for the same while 6 patients reported persisting knee pain and instability as reasons for a fall in their sporting abilities. The difference in the scores of these groups was statistically significant. 8 patients out of the 48 had left sports completely due to reasons other than sports, even though they had good knee outcome scores. Conclusion. Fear of reinjury and psychosocial issues that are relevant to the social milieu of the athlete are very important and affect the overall results of the surgery with respect to return to sports. PMID:24977065

Devgan, Ashish; Magu, N. K.; Siwach, R. C.; Rohilla, Rajesh; Sangwan, S. S.

2011-01-01

8

A comparison of early and delayed arthroscopically-assisted reconstruction of the anterior cruciate ligament using hamstring autograft.  

PubMed

Delayed rather than early reconstruction of the anterior cruciate ligament is the current recommended treatment for injury to this ligament since it is thought to give a better functional outcome. We randomised 105 consecutive patients with injury associated with chondral lesions no more severe than grades 1 and 2 and/or meniscal tears which only required trimming, to early (< two weeks) or delayed (> four to six weeks) reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft. All operations were performed by a single surgeon and a standard rehabilitation regime was followed in both groups. The outcomes were assessed using the Lysholm score, the Tegner score and measurement of the range of movement. Stability was assessed by clinical tests and measurements taken with the KT-1000 arthrometer, with all testing performed by a blinded uninvolved experienced observer. A total of six patients were lost to follow-up, with 48 patients assigned to the delayed group and 51 to the early group. None was a competitive athlete. The mean interval between injury and the surgery was seven days (2 to 14) in the early group and 32 days (29 to 42) in the delayed group. The mean follow-up was 32 months (26 to 36). The results did not show a statistically significant difference for the Lysholm score (p = 0.86), Tegner activity score (p = 0.913) or the range of movement (p = 1). Similarly, no distinction could be made for stability testing by clinical examination (p = 0.56) and measurements with the KT-1000 arthrometer (p = 0.93). Reconstruction of the anterior cruciate ligament gave a similar clinical and functional outcome whether performed early (< two weeks) or late at four to six weeks after injury. PMID:20357328

Raviraj, A; Anand, A; Kodikal, G; Chandrashekar, M; Pai, S

2010-04-01

9

Two-incision anterior cruciate ligament reconstruction.  

PubMed

Two-incision or rear-entry anterior cruciate ligament (ACL) reconstruction has value from a historical perspective as the original method for arthroscopically assisted reconstructions. As endoscopic approaches became popular it became less commonly utilized. It remains an important technique and has become even more relevant as the discussion of tunnel placement has evolved. It allows independent placement from the tibial tunnel and can be easier to accomplish than anteromedial tunnel drilling. It has also gained favor as a technique to ease performing revision reconstructions following previous endoscopic reconstructions. This review discusses the historical and clinical issues involved with two-incision ACL reconstruction. PMID:24992342

Wright, Rick W

2014-10-01

10

Bioengineered anterior cruciate ligament  

NASA Technical Reports Server (NTRS)

The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the particular developing tissue, some examples of the stimuli being chemical stimuli, and electro-magnetic stimuli. Some examples of tissue which can be produced include other ligaments in the body (hand, wrist, elbow, knee), tendon, cartilage, bone, muscle, and blood vessels.

Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

2001-01-01

11

Health-related quality of life in patients with anterior cruciate ligament insufficiency undergoing arthroscopic reconstruction: a practice-based Italian normative group in comorbid-free patients  

Microsoft Academic Search

Background  Health-related quality of life (HRQoL) in anterior cruciate ligament (ACL) insufficiency has not been assessed in comorbid-free\\u000a patients to date. An observational study was therefore conducted on a practice-based sample to test the hypothesis that SF-36\\u000a scoring in patients with chronic ACL insufficiency differs from the age- and gender-matched Italian norm.\\u000a \\u000a \\u000a \\u000a Materials and methods  Chronically ACL-insufficient patients with or without meniscal

V. Calvisi; B. De Vincentiis; P. Palumbo; R. Padua; S. Lupparelli

2008-01-01

12

Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption  

Microsoft Academic Search

Instrumented anterior\\/posterior laxity measurements were performed on 138 patients evaluated within 2 weeks of injury with their first traumatic knee hemar throsis. All patients were tested with the MEDmetric Arthrometer model KT-1000 in a knee injury clinic. Seventy-five of the patients had knee arthroscopy. Thirty-three had arthrometer laxity tests under anes thesia. Eighty-seven percent of patients arthroscoped had anterior cruciate

Dale M. Daniel; Mary Lou Stone; Raymond Sachs; Lawrence Malcom

1985-01-01

13

Pediatric anterior cruciate ligament reconstruction  

Microsoft Academic Search

An increasing number of anterior cruciate ligament (ACL) injuries are seen in children now than in the past due to increased\\u000a sports participation. The natural history of ACL deficient knees in active individuals, particularly in children is poor.\\u000a Surgical management of ACL deficiency in children is complex due to the potential risk of injury to the physis and growth\\u000a disturbance.

Mark O. McConkey; Davide Edoardo Bonasia; Annunziato Amendola

2011-01-01

14

Anterior cruciate: methods of physical examination.  

PubMed

Tear of the anterior cruciate ligament is a common, serious injury. Since the long-range consequences of uncorrected anterior cruciate incompetence are better understood, and surgical and rehabilitative measures improved, early accurate diagnosis is increasingly important. Besides a careful history, diagnosis requires the use of specific physical examination methods to reproduce the symptomatic subluxation (anterior shift or internal rotation) and to assess functional performance of the knee. PMID:21286055

Grant, J; Kirby, R L

1982-02-01

15

Anomalous insertion of the medial meniscus into the anterior cruciate ligament: the MR appearance  

Microsoft Academic Search

The aim of this study was to determine the characteristic MR findings of the anomalous insertion of the medial meniscus (AIMM) into the anterior cruciate ligament (ACL), and to document potential pitfalls in its interpretation. We reviewed 1326 consecutive knee arthroscopic studies to identify patients with an AIMM. 30 knees of 26 patients (4 females, 22 males; average age, 31.3

J-G Cha; K-D Min; J-K Han; H-S Hong; S-J Park; J-S Park; S-H Paik

2007-01-01

16

Strain Inhomogeneity in the Anterior Cruciate Ligament  

E-print Network

be needed to predict injury ofthe anterior cruciate ligament (ACL), Richmond, CA 94804 this work tested the application ofa number of loads important to injury etiology of the ACL. To provide the data for testing, moments, quadriceps, and hamstrings forces. Various combinations of these loads Davis, CA 95616 were also

Hull, Maury

17

Abnormal femoral origin of the anterior cruciate ligament combined with a discoid lateral meniscus  

Microsoft Academic Search

This is a report on arthroscopic treatment of an abnormal femoral origin of the anterior cruciate ligament (ACL) in combination with a discoid lateral meniscus in a 3-year-old child. The discoid lateral meniscus was treated by resection of the inner part with punches and by use of the holmium:YAG laser. The abnormal femoral origin of the ACL which was found

Frank F. Hoffmann

1997-01-01

18

The O'Donoghue triad revisitedCombined knee injuries involving anterior cruciate and medial collateral ligament tears  

Microsoft Academic Search

We identified 60 consecutive patients with combined anterior cruciate and medial collateral ligament (ACL- MCL) disruptions that were incurred during athletic endeavors. Each underwent acute reconstruction of the ACL. The arthroscopic data obtained at the time of reconstructive surgery was reviewed in order to deter mine the incidence of O'Donoghue's triad (the \\

K. Donald Shelbourne; Paul A. Nitz

1991-01-01

19

Parsons' knob (tuberculum intercondylare tertium). A guide to tibial anterior cruciate ligament insertion.  

PubMed

In some human autopsy specimens, a bony prominence located anterior to the tibial eminences represents the confluent insertion of the anterior horn medial meniscus and the medial fibers of the anterior cruciate ligament (ACL). The prominence has been called "Parsons' knob" by anatomists and the "tuberculum intercondylare tertium" by radiologists. This article reviews the anatomy and provides the first magnetic resonance image study and perhaps the first roentgenographic depiction of this landmark in the English-speaking orthopedic literature. This structure, if noted preoperatively, can be helpful in identifying the appropriate site of tibial tunnel placement for ACL reconstructive operations performed under arthroscopic or fluoroscopic guidance. PMID:8519113

Berg, E E

1993-07-01

20

Mucoid degeneration of the anterior cruciate ligament: Management and outcome  

PubMed Central

Background: Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Mucinous material within the substance of ACL produces pain and limited motion in the knee. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. Materials and Methods: During a period of 3 years, 11 patients were included based upon the clinical suspicion, magnetic resonance imaging (MRI) findings, arthroscopic features and histopathologic confirmation of MD of ACL. Result: Six patients were male and five were female with median age of 40 years (range 21-59 years). All patients complained of knee pain with median duration of 5 months (range 1-24 months). All patients had painful deep flexion with 63.6% (N = 7) reporting trivial trauma before the onset of symptoms. MRI revealed MD of ACL in all with associated cyst in three patients. Partial debridement of ACL was done in ten and complete in one patient. None of them required notchplasty. Histopathology confirmed the diagnosis in all of them. At the mean followup of 13.81 months (range 6-28 months), all patients regained complete flexion and none complained of instability. Conclusion: Prior knowledge of condition with high index of suspicion and careful interpretation of MRI can establish the diagnosis preoperatively. It responds well to partial debridement of ACL and mucinous material without development of instability. PMID:24741143

Pandey, Vivek; Suman, CPS; Sharma, Swati; Rao, Sripathi P; Kiran Acharya, KV; Sambaji, Charudutt

2014-01-01

21

[Anterior cruciate ligament injuries in children].  

PubMed

An increasing number of anterior cruciate ligament injuries are now seen in children and girls seem to be equally affected. Such neglected or untreated lesions could be the cause of early degenerative changes. Recently, many authors support the trend toward early surgical management in skeletally immature patients with complex meniscal tear or recurrent knee instability after proper rehabilitation. Improvement in pediatric knowledge and surgical techniques tend to support a tendency for more surgical treatment in children. The type of management is choosing according to history and physical examination. Magnetic resonance imaging is a useful tool not only for diagnosis but also for surgical treatment planning. We usually recommend anterior cruciate ligament reconstruction in children with knee instability or with further damages to the joint. PMID:23971325

Tercier, S; Zambelli, P-Y

2013-07-17

22

Graft healing in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood\\u000a biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge\\u000a of this process have been made based primarly on animal models. According to the findings of this review, some surgical and\\u000a postoperative variables are known to

Max Ekdahl; James H.-C. Wang; Mario Ronga; Freddie H. Fu

2008-01-01

23

Imaging of the anterior cruciate ligament  

PubMed Central

The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

2011-01-01

24

Radiographic evidence of anterior cruciate ligament insufficiency.  

PubMed

Anterior cruciate ligament (ACL) tears are commonly seen injuries. Initially, these injuries are routinely evaluated with radiographs, followed by magnetic resonance imaging (MRI). The altered kinematics at the time of injury or for the duration of a chronic tear can create indirect findings on radiographs and MRI. These signs may help establish a diagnosis of an ACL tear or the chronicity of the injury. This article discusses these signs. [Orthopedics. 2014; 37(11):759-762.]. PMID:25361360

Johnson, Darren L; Brunkhorst, Joseph; Johnson, Darren L

2014-11-01

25

Current concepts in the treatment of anterior cruciate ligament disruption.  

PubMed

Treatment of anterior cruciate ligament injuries has changed considerably in recent years. The purpose of this paper is to discuss the past and present treatment for anterior cruciate ligament (ACL) disruptions in athletic individuals. In addition, this paper will discuss current trends in rehabilitation, such as immediate motion, weight bearing, and close kinetic chain exercises, and provide the scientific rationale for these rehabilitation principles. The treatment of individuals who have suffered an ACL disruption has changed dramatically over the years. The treatment of ACL ruptures has made a full circle. The first reconstructive procedure described used a patellar tendon graft. Then primary ACL repairs were advocated. With the limited success of that procedure, the nonoperative treatment was popularized, with reconstruction performed only after the conservative program failed. With this treatment plan, clinicians noted early degenerative joint changes and an increase in meniscus tears in the ACL deficient knee. Thus, reconstructive surgery using a patellar tendon graft was again advocated. Today, the current trend in the treatment of ACL tears is an arthroscopically assisted procedure to reconstruct the ACL using a bone-tendon-bone graft, such as a patellar tendon. The surgery employs accurate graft placement, tensioning, and fixation, which allows the therapist the opportunity to utilize immediate motion and weight bearing, in addition to strengthening exercises. This paper attempts to explain the rehabilitation process following ACL reconstruction using current scientific and clinical research. The program is based on the anatomy, biomechanics, and healing process of the knee, joint, and ACL. The clinical implications of this paper are numerous. First, we believe the information will assist clinicians in developing their own programs. Second, the data will assist the reader in understanding the sequential healing process. Finally, this paper documents that immediate aggressive rehabilitation is not deleterious to the ACL graft, and early therapy improves the functional outcome. J Orthop Sports Phys Ther 1992;15(6):279-293. PMID:18781001

Wilk, K E; Andrews, J R

1992-01-01

26

Anterior cruciate ligament reconstruction in patients older than 35 years.  

PubMed

Anterior cruciate ligament (ACL) reconstruction is an increasingly established method even in patients older than 35 years. Our hypothesis is that functional outcome after ACL reconstruction is comparable in patients younger and older than 35 years. A total of 28 patients (5 women and 23 men) with average age of 41.5 years (36-68) were retrospectively evaluated. The average follow-up period was 33 months. All of them were treated operatively with arthroscopic single-bundle four-strand hamstring tendon autograft. The functional outcome was determined by clinical scores (Tegner activity scale and Lysholm knee score). The median values for the Lysholm knee score were preoperatively 77 and postoperatively 96 points (range, 90-100) with significant improvement (p?anterior knee instability. We commonly propose surgical treatment in symptomatic patients who express the need to restore their preinjury activity levels, regardless of their age. PMID:24510521

El-Sallakh, Sameh; Pastides, Philip; Thomas, Panos

2014-12-01

27

Anterior Cruciate Ligament Insufficiency: Principles of Treatment.  

PubMed

Anterior cruciate ligament (ACL) injuries often result in functional disability, particularly in jumping, cutting, and deceleration activities. Some patients can accommodate to this functional loss, while others require surgical reconstruction of the ligament to provide stability and to protect the meniscus from further injury. Nonoperative management involves an intensive rehabilitation program, patient counseling about high-risk activities, and measures to prevent recurrent injuries. Surgical reconstruction of the ACL involves the technical factors of graft selection, positioning, fixation, and tensioning and the avoidance of stress risers. A supervised and intensive rehabilitation program is necessary to achieve optimal results. PMID:10708991

Larson; Tailon

1994-01-01

28

Tunnel enlargement after anterior cruciate ligament surgery.  

PubMed

Bone tunnel enlargement has been reported after anterior cruciate ligament (ACL) reconstruction surgery. Although the long-term outcome of this phenomenon is not yet known, tunnel lysis or expansion may be clinically significant in revision surgery because the enlarged tunnels may complicate graft placement and fixation. There any many proposed theories for tunnel lysis. The most accurate statement is that this condition has a multifactorial etiology. Mechanical and biological causes have been reported, and both contribute to enlarged graft tunnels. This article describes the multiple causes of bone tunnel enlargement after ACL surgery. Future techniques and advances in primary ACL surgery must seek to eliminate this phenomenon. PMID:14977688

Wilson, Timothy C; Kantaras, Anthony; Atay, Ahmet; Johnson, Darren L

2004-03-01

29

Preoperative cryotherapy use in anterior cruciate ligament reconstruction.  

PubMed

Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p?

Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

2014-12-01

30

Prospective Correlation Between Serum Relaxin Concentration and Anterior Cruciate Ligament Tears Among Elite Collegiate Female Athletes  

Microsoft Academic Search

Background: The female anterior cruciate ligament may be more susceptible to injury than the male anterior cruciate ligament because of the gender-specific expression of receptors for relaxin, a collagenolytic hormone that promotes remodeling of the anterior cruciate ligament.Purpose: This study was undertaken to investigate whether collegiate female athletes with elevated serum relaxin concentrations (SRC) sustain anterior cruciate ligament tears at

Jason L. Dragoo; Tiffany N. Castillo; Hillary J. Braun; Bethany A. Ridley; Ashleigh C. Kennedy; S. Raymond Golish

2011-01-01

31

Changes in biochemical parameters after anterior cruciate ligament injury  

PubMed Central

We studied the biochemical characteristics of human knees with deficient anterior cruciate ligaments (ACL) and analysed their relationship to the time after ligamentous injury. Thirty-two patients with isolated ACL-injured knees and six healthy volunteers were enrolled. Synovial fluid samples were centrifuged after aspiration during arthroscopic examination, and aliquots of supernatant were frozen and stored at ?80°C. The samples were analysed for interleukin (IL)-1?, tumour necrosis factor (TNF)-?, IL-6, matrix metalloproteinase (MMP)-3, and tissue inhibitor of metalloproteinase (TIMP)-1 using commercially available sandwich enzyme-linked immunosorbent assay. In fluid from ACL-injured knees, the average concentrations of IL-6, MMP-3 and TIMP-1 were highly elevated in comparison with normal controls. There was a statistically significant correlation between the concentrations of MMP-3 and IL-6. The IL-6 and TIMP-1 concentrations were interrelated. The concentration of MMP-3 remained high, independent of the duration since the injury, whereas the TIMP-1 and IL-6 levels decreased. The results suggest that the timing of the treatment of an ACL-injured knee might be of importance. PMID:16333657

Shirakura, K.; Kimura, M.; Terauchi, M.; Shinozaki, T.; Watanabe, H.; Takagishi, K.

2005-01-01

32

Discoid medial meniscus completely coalesced with the anterior cruciate ligament.  

PubMed

Discoid meniscus is an abnormality of the knee in which the meniscus is discoid rather than semilunar in shape. Medial discoid menisci are rare, and no specific associated symptoms suggest this condition. Several medial meniscus anomalies, including discoid variants, have been reported in the literature. This article describes a rare case of medial discoid meniscus completely coalesced with the anterior cruciate ligament (ACL). A 22-year-old man presented with intermittent right knee pain of 6 months' duration. Physical examination revealed mild wasting of the quadriceps with medial joint line tenderness but no effusion. Radiographically, hypoplasia of the lateral tibial spine, increased medial joint space, and increased concavity of the medial tibial condyle were noted in both knees. Arthroscopic examination revealed a complete discoid medial meniscus that was contiguous with the ACL. On probing, a horizontal tear in the medial meniscus was noted. A meniscectomy was performed, and deep longitudinal furrows with exposed subchondral bone were noted underlying the posteromedial tibial condyle. At the patient's 6-month follow-up visit, he had no knee symptoms and had returned to his daily activities, which included jogging. Discoid medial meniscus is a rare anomaly, and this case represents only the second reported in the literature of discoid medial meniscus completely coalesced with ACL. This case supports the theory that the ACL and menisci can be differentiated from 1 mesenchyme. PMID:24200455

Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Chaudhary, Deepak

2013-11-01

33

Anterior cruciate ligament tears: reconstruction and rehabilitation.  

PubMed

Tears of the anterior cruciate ligament (ACL) are common knee injuries experienced by athletes and people with active lifestyles. It is important for members of the healthcare team to take an evidence-based approach to the diagnosis, surgical management, and postoperative rehabilitation of patients with an ACL-deficient knee. Mechanism of ACL injury and diagnostic testing is consistent throughout the literature. Patients frequently opt for ACL reconstruction, and many surgical techniques for ACL reconstruction are available with no clear consensus regarding superiority. Surgeon preference dictates the type of reconstruction and graft choice utilized. No standardized pre- and postoperative rehabilitation protocol exists. However, rehabilitation plays an important role in functional outcomes. A comprehensive rehabilitation program is needed pre- and postoperatively to produce positive patient outcomes. PMID:24457384

Smith, Mary Atkinson; Smith, W Todd; Kosko, Paul

2014-01-01

34

Anterior Cruciate Ligament Rupture and Osteoarthritis Progression  

PubMed Central

Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial. The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction. There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations. PMID:22896777

Wong, James Min-Leong; Khan, Tanvir; Jayadev, Chethan S; Khan, Wasim; Johnstone, David

2012-01-01

35

Graft healing in anterior cruciate ligament reconstruction  

PubMed Central

Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation and direct fibrocartilage fixation confer different anchorage strength and interface properties at the tendon-bone interface. For enhancing tendon graft-to-bone healing, we introduce a strategy that includes the use of periosteum, hydrogel supplemented with periosteal progenitor cells and bone morphogenetic protein-2, and a periosteal progenitor cell sheet. Future studies include the use of cytokines, gene therapy, stem cells, platelet-rich plasma, and mechanical stress for tendon-to-bone healing. These strategies are currently under investigation, and will be applied in the clinical setting in the near future. PMID:19772670

Chen, Chih-Hwa

2009-01-01

36

Design of a novel anterior cruciate ligament prosthesis  

E-print Network

Injuries to the anterior cruciate ligament (ACL) are extremely common (approximately 100,000 every year in the US) and result in greatly reduced mobility; although several surgical procedures have been devised to address ...

Talei Franzesi, Giovanni

2006-01-01

37

Digital infrared thermal imaging following anterior cruciate ligament reconstruction.  

PubMed

This case describes the selective use of digital infrared thermal imaging for a 48-year-old woman who was being treated by a physical therapist following left anterior cruciate ligament (ACL) reconstruction with a semitendinosus autograft. PMID:22383168

Barker, Lauren E; Markowski, Alycia M; Henneman, Kimberly

2012-03-01

38

Arthroscopic versus open treatment of anterior shoulder instability.  

PubMed

Open repair is the accepted mainstay of treatment for anterior shoulder instability, and consistently good clinical results have been reported in the literature. With the development of newer arthroscopic imbrication techniques, however, arthroscopy may eventually provide equivalent long-term efficacy. PMID:15116644

Armstrong, April; Boyer, Dory; Ditsios, Konstantinos; Yamaguchi, Ken

2004-01-01

39

Radiation Exposure During Fluoroarthroscopically Assisted Anterior Cruciate Reconstruction  

Microsoft Academic Search

We prospectively evaluated the radiation exposure dur ing 50 consecutive fluoroscopically assisted anterior cruciate ligament reconstructions. Three different meth ods of anterior cruciate ligament reconstruction were performed using either rolled fascia lata allograft or bone-tendon-bone autograft. For the 50 procedures, to tal time using the fluoroscope was 119.61 minutes, or 2.38 minutes per procedure. The 16 primary fascia lata allograft

Brad J. Larson; Julie Egbert; E. Marlowe Goble

1995-01-01

40

Arthroscopic anterior cruciate ligament surgery: results of autogenous patellar tendon graft versus the Leeds-Keio synthetic graft five year follow-up of a prospective randomised controlled trial.  

PubMed

We conducted a prospective, randomised controlled trial comparing anterior cruciate ligament reconstruction using middle third patellar tendon graft (PT) to synthetic Leeds-Keio (LK) ligament. The patients were randomised (26 PT, 24 LK). Subjective knee function was classified (Lysholm, Tegner activity, IKDC scores), laxity was measured (Lachman test, Stryker laxometer), and functional ability was assessed (one-hop test). There were no significant differences between Lysholm or IKDC scores at any stage by 5 years. Significant differences were found between the groups at 2 years for Tegner activity scores, laxity and one-hop testing. By 5 years there were no significant differences. Clinical equivalence was demonstrated between the two groups for the Lysholm score and one-hop test but not for the Tegner activity score at 5 years. The use of the LK ligament has been largely abandoned due to reports of its insufficiency. Our results demonstrate that it is not as inferior as one might expect. We conclude that the results of LK ligament ACL reconstruction are as acceptable as those using PT. It may provide an additional means of reconstruction where no suitable alternative is present. PMID:19861236

Ghalayini, S R A; Helm, A T; Bonshahi, A Y; Lavender, A; Johnson, D S; Smith, R B

2010-10-01

41

Anterior cruciate ligament surgery in the rabbit  

PubMed Central

Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery. PMID:23957941

2013-01-01

42

Guideline on anterior cruciate ligament injury  

PubMed Central

The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

2012-01-01

43

Principles of postoperative anterior cruciate ligament rehabilitation  

PubMed Central

It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

Saka, Tolga

2014-01-01

44

Mechanisms of anterior cruciate ligament injury.  

PubMed

This study examined the mechanisms of anterior cruciate ligament (ACL) injury. In the first part of the study, using a comprehensive, standardized questionnaire, 89 athletes (100 knees) were interviewed about the events surrounding their ACL injury. A noncontact mechanism was reported in 71 (72%) knees and a contact injury in 28 (28%) knees; one patient was unsure if there was any contact. Most of the injuries were sustained at footstrike with the knee close to full extension. Noncontact mechanisms were classified as sudden deceleration prior to a change of direction or landing motion, while contact injuries occurred as a result of valgus collapse of the knee. Hamstring flexibility parameters revealed a statistically higher level of laxity in the injured athletes compared with a matched group of 28 controls. In the second part of the study, videotapes of 27 separate ACL disruptions were reviewed and confirmed that most noncontact injuries occur with the knee close to extension during a sharp deceleration or landing maneuver. Because the knee is in a position to allow the extensor mechanism to strain the ACL and maximum, eccentric muscle force conditions usually apply, the quadriceps may play an important role in ACL disruption. Passive protection of the ACL by the hamstring muscles may be reduced in patients with above-average flexibility. PMID:10875418

Boden, B P; Dean, G S; Feagin, J A; Garrett, W E

2000-06-01

45

Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft  

Microsoft Academic Search

We present a retrospective study of 24 patients with chronic injury of the posterior cruciate ligament (PCL) treated by arthroscopically\\u000a assisted reconstruction with bone-tendon-bone patellar autograft. At a mean follow-up of 26.5 months (range 24–53 months)\\u000a the International Knee Documentation Committee (IKDC) evaluation form, Lysholm and Tegner rating systems were used to evaluate\\u000a symptoms, functional limitations during sports and daily

P. P. Mariani; E. Adriani; N. Santori; G. Maresca

1997-01-01

46

Anterior Cruciate Ligament Allograft Reconstruction in the Skeletally Immature Athlete  

Microsoft Academic Search

The purpose of this study was to evaluate anterior cru ciate ligament allograft reconstruction in skeletally im mature athletes. Eight patients (mean age, 13 years, 6 months; range, 10 to 15 years) with radiographic docu mentation of open growth plates had anterior cruciate ligament repair and reconstruction with fascia lata or Achilles tendon allograft tissue. A 7-mm graft was cen

Michelle Andrews; Frank R. Noyes; Sue D. Barber-Westin

1994-01-01

47

Double-stranded hamstring graft for anterior cruciate ligament reconstruction  

Microsoft Academic Search

Current techniques for anterior cruciate ligament (ACL) reconstruction do not completely reproduce the anatomy and function of the ACL. They address only the anteromedial bundle and do not fully restore ACL function throughout the range of motion. Current grafts control anterior tibial subluxation near extension, but are less efficacious in providing rotatory stability. Recently, several authors have suggested reconstructing not

Guy Bellier; Pascal Christel; Philippe Colombet; Patrick Djian; Jean Pierre Franceschi; Abdou Sbihi

2004-01-01

48

Aggressive Quadriceps Loading Can Induce Noncontact Anterior Cruciate Ligament Injury  

Microsoft Academic Search

Background: The force responsible for noncontact anterior cruciate ligament (ACL) injuries remains controversial. The patella tendon to tibial shaft angle causes an anterior tibial shear force with quadriceps activation.Hypothesis: An aggressive quadriceps contraction can injure the ACL.Methods: The authors characterized noncontact ACL injury and kinematics with aggressive quadriceps loading. Thirteen freshfrozen knees were potted in a jig held in 20

Gene Demorat; Paul Weinhold; Troy Blackburn; Steven Chudik; William Garrett

2004-01-01

49

The Anterior Cruciate Ligament Tear Rate Varies by Race in Professional Women's Basketball  

Microsoft Academic Search

Background: Female basketball players are more likely to tear their anterior cruciate ligament than are their male counterparts. Many causes are postulated for the difference observed in the rate of anterior cruciate ligament tears between genders. However, little is known about the differences in tears within gender.Hypothesis: The rate of anterior cruciate ligament tears is different in White European American

Thomas H. Trojian; Seamus Collins

2006-01-01

50

Arthroscopic management of anterior shoulder instability with glenoid bone defects.  

PubMed

Bony deficiency of the anterior glenoid rim may significantly contribute to recurrent shoulder instability. Today, based on clinical and biomechanical data, a bony reconstruction is recommended in patients with bone loss of greater than 20-25 % of the glenoid surface area. Recent advances in arthroscopic instruments and techniques presently allow minimally invasive and arthroscopic reconstruction of glenoid bone defects and osteosynthesis of glenoid fractures. This article underlines the role of glenoid bone deficiency in recurrent shoulder instability, provides an update on the current management regarding this pathology and highlights the modern techniques for surgical treatment. Therefore, it can help orthopaedic surgeons in the treatment and decision-making when dealing with these difficult to treat patients in daily clinical practice. PMID:22976501

Martetschläger, Frank; Kraus, Tobias M; Hardy, Philippe; Millett, Peter J

2013-12-01

51

Proprioception in the anterior cruciate deficient knee  

Microsoft Academic Search

Proprioception was quantified in a group of patients who had documented complete ACL tears. Threshold to detection of passive change in position of the knee was measured using a well-described test. Eleven pa tients with arthroscopically proven complete ACL tears and findings consistent with moderate to severe anter olateral rotatory instability were tested. Testing was done within the 30° to

Robert L. Barrack; Harry B. Skinner; Steven L. Buckley

1989-01-01

52

Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity  

PubMed Central

Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

Kim, Sung-Jae; Kumar, Praveen

2010-01-01

53

Polypropylene braid augmented and nonaugmented intraarticular anterior cruciate ligament reconstruction  

Microsoft Academic Search

The purpose of this clinical retrospective study is to determine whether a polypropylene braid (PB) used to augment an intraarticular autograft to reconstruct the anterior cruciate ligament (ACL) is safe and to deter mine whether the PB improves the efficacy of the procedure.A simultaneous review was performed of patients who had undergone an intraarticular ACL reconstruc tion using an autograft

James H. Roth; John C. Kennedy; Harry Lockstadt; Catherine L. Mccallum; Leonard A. Cunning

1985-01-01

54

Semitendinosus muscle in anterior cruciate ligament surgery: Morphology and function  

Microsoft Academic Search

Purpose: To evaluate the fate of the hamstring muscles in general and the semitendinosus muscle in particular, after anterior cruciate ligament (ACL) reconstruction with an autologous semitendinosus tendon graft from the ipsilateral side. Type of Study: Prospective consecutive case series investigation. Methods: Included were 16 consecutive patients, 14 male and 2 female, with a mean age of 26 years. The

Karl Eriksson; Per Hamberg; Eva Jansson; Hans Larsson; Adel Shalabi; Torsten Wredmark

2001-01-01

55

Anterior Cruciate Ligament Injuries in Soccer Players : An Overview  

Microsoft Academic Search

Soccer is known as a sport with high risk of anterior cruciate ligament (ACL) injury. Until 1980s, an ACL injury was a career-ending injury for a soccer player, but afterwards with the technological advancement in the field of medical sciences it could be treated or cured to a greater extent. Prevalence of this injury is two times greater among female

Amit Bandyopadhyay; Shazlin Shaharudin

2009-01-01

56

Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction  

Microsoft Academic Search

Meniscal repair is preferable to meniscectomy because of the recognized benefits of the meniscus and the consequences of its loss. The most appropriate rehabilitation program after meniscus repair is unclear. Many meniscus repairs occur in association with anterior cruciate ligament (ACL) reconstructions. An accelerated program permitting early full weight bearing, unrestricted motion, and no limitations on pivoting sports after the

F. Alan Barber; Sarah D. Click

1997-01-01

57

Criterion-based rehabilitation program after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Traditional rehabilitation protocols consist of a progression of exercises and functional activities based on timeframes that serve as strict guidelines for physical therapists and athletic trainers. Patients who have undergone reconstruction of the anterior cruciate ligament are guided through the process via written schedule which often overlooks their ability to master basic functional activities, such as walking. Basic science and

Elizabeth A. Eckersley; Julie M. Fritz; James J. Irrgang

1995-01-01

58

Behavior of sutures used in anterior cruciate ligament reconstructive surgery  

Microsoft Academic Search

This study was performed to determine the material properties of sutures commonly used in orthopedic surgery in order to allow selection of the most appropriate one for securing a hamstring or quadriceps tendon graft in anterior cruciate ligament (ACL) reconstruction. Three suture materials (number 5 Ticron, number 5 Ethibond, and 5 mm Mersilene tape) were tested. The ultimate tensile load

E. E. Spencer; H. R. Chissell; J. T. Spang; J. A. Feagin Jr

1996-01-01

59

Experimental studies of acute anterior cruciate ligament injury and repair  

Microsoft Academic Search

Ten dogs and six rhesus monkeys underwent transection and repair of the anterior cruciate ligament. One-half of the pro cedures involved the femoral end, the other half involved the tibial end of the ligament. Seven of the 10 canine and all of the primate ligaments, that had been transected and repaired, did heal. Functional and clinical instability was demonstrable in

H. Edward Cabaud; William G. Rodkey; John A. Feagin

1979-01-01

60

Reconstruction of the anterior cruciate ligament using a double bundle  

Microsoft Academic Search

Summary: We developed a reconstruction technique for the anterior cruciate ligament using a double bundle that is the combination of bone-tendon-bone (BTB) from the patellar tendon and semitendinosus tendon (ST). BTB is fixed in the tunnels produced on the isometric points on the tibia and femur. ST is fixed on the tibial tunnel through the same route as the BTB,

Kunio Hara; Toshikazu Kubo; Takehiko Suginoshita; Choji Shimizu; Yasusuke Hirasawa

2000-01-01

61

Arthroscopic management of shoulder instabilities: anterior, posterior, and multidirectional.  

PubMed

Arthroscopy is considered a relatively new technique for the surgical repair of an unstable shoulder. Shoulder arthroscopy has grown in popularity and is considered the gold standard for treating carefully selected patients. Despite its increasing popularity, the procedure has a significant learning curve and has resulted in early higher recurrence rates when compared with patients treated with open techniques. With the addition of newer instrumentation, the refinement of techniques, and additional capsular plication and tensioning, outcomes for patients treated with shoulder arthroscopy should continue to improve. A major distinguishing feature in selecting appropriate candidates for shoulder arthroscopy is whether there have been significant bone changes resulting from dislocation recurrence. Recurrent anterior dislocation may create an anterior glenoid rim fracture, erosion loss from multiple recurrences, and an impression defect on the posterior aspect of the humeral head. The loss of contact area between the "ball and cup" may compromise the results of techniques that restore the anatomic restraints of soft tissues. Early intervention is becoming recognized as an important factor in patient selection for arthroscopic treatment. Imaging studies after traumatic injuries include radiographs, CT scans, possible articular contrast studies, and MRIs. These studies can identify and quantify rim fractures and the remaining articular contact in patients with recurrent subluxations, allowing for earlier appropriate intervention. Patients with significant bone loss may be best treated with an open procedure that allows grafting of the deficiency. Arthroscopic techniques to repair fractures or graft deficiencies continue to evolve. Rim fractures can be anatomically repaired with a suture anchor technique when recognized early. Rim erosion from chronic recurrent dislocations may require a combination of soft-tissue reattachment and coracoid grafting. Humeral head defects may require either soft-tissue or bone grafting to avoid engagement with the anterior edge of the glenoid. These techniques require arthroscopic skill and experience and are currently being performed as open procedures. In the future, it is likely that arthroscopy will be involved in the entire spectrum of treatment for shoulder instability. PMID:20415377

Abrams, Jeffrey S; Bradley, James P; Angelo, Richard L; Burks, Robert

2010-01-01

62

Double-bundle anterior cruciate ligament reconstruction in a skeletally immature adolescent athlete.  

PubMed

We present a technique for double-bundle anterior cruciate ligament (ACL) reconstruction in a 14-year-old female athlete. The patient presented with anterolateral knee rotatory instability following a traumatic injury suffered while practicing judo. The clinical examination revealed positive Lachman and pivot shift tests with no accompanying meniscal pathology. Roentgenograms revealed open physes, and magnetic resonance imaging scans confirmed an isolated midsubstance ACL tear without cartilaginous injury. The decision was made to anatomically reconstruct the ACL because the athlete wished to continue competitive judo. Autologous hamstring tendons were harvested for double-bundle ACL repair. Following arthroscopic retrograde femoral and antegrade tibial tunnel placement, the ligaments were secured using interference screws within the femoral and tibial epiphysis. Postoperative Lachman and pivot shift tests were negative. PMID:19245996

Salzmann, Gian M; Spang, Jeffrey T; Imhoff, Andreas B

2009-03-01

63

Anterior cruciate ligament recostruction with bone-patellar tendon-bone autograft in Tanner 3 stage patients with open physes.  

PubMed

Ten skeletally immature patients were treated with an arthroscopic-assisted anterior cruciate ligament reconstruction with bone-patellar tendon bone autograft (compass, 50-55°; holes, 7-9 mm). Radiological assessments (standard radiograph), Orthopädische Arbeitsgruppe Knie (OAK) score and KT 1000, were conducted on all patients, 1 year after surgery. Skeletal maturity had been reached by all patients and no complications were observed. All patients returned to their preinjury sport level. Drilling more vertical tunnels when bone-tendon-bone autograft was chosen to avoid partial epiphysiodesis and offers good functional and isometric results. PMID:21886009

Memeo, Antonio; Pedretti, Leopoldo; Miola, Francesca; Albisetti, Walter

2012-09-01

64

Activity progression for anterior cruciate ligament injured individuals?  

PubMed Central

Background Functional exercises are important in the rehabilitation of anterior cruciate ligament deficient and reconstructed individuals but movement compensations and incomplete recovery persist. This study aimed to identify how tasks pose different challenges; and evaluate if different activities challenge patient groups differently compared to controls. Methods Motion and force data were collected during distance hop, squatting and gait for 20 anterior cruciate ligament deficient, 21 reconstructed and 21 controls. Findings Knee range of motion was greatest during squatting, intermediate during hopping and smallest during gait (P < 0.01). Peak internal knee extensor moments were greatest during distance hop (P < 0.01). The mean value of peak knee moments was reduced in squatting and gait (P < 0.01) compared to hop. Peak internal extensor moments were significantly larger during squatting than gait and peak external adductor moments during gait compared to squatting (P < 0.01). Fluency was highest during squatting (P < 0.01). All patients demonstrated good recovery of gait but anterior cruciate ligament deficient adopted a strategy of increased fluency (P < 0.01). During squatting knee range of motion and peak internal knee extensor moment were reduced in all patients (P < 0.01). Both anterior cruciate ligament groups hopped a shorter distance (P < 0.01) and had reduced knee range of motion (P < 0.025). Anterior cruciate ligament reconstructed had reduced fluency (P < 0.01). Interpretation Distance hop was most challenging; squatting and gait were of similar difficulty but challenged patients in different ways. Despite squatting being an early, less challenging exercise, numerous compensation strategies were identified, indicating that this may be more challenging than gait. PMID:24447417

Button, Kate; Roos, Paulien E.; van Deursen, Robert W.M.

2014-01-01

65

Popliteal Pseudoaneurysm after Arthroscopic Posterior Cruciate Ligament Reconstruction  

PubMed Central

This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature. PMID:25229050

Breugem, Stefan J.M.; Driessen, Marcel J.M.

2014-01-01

66

Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction  

PubMed Central

Four-strand hamstring autograft is a common choice for anterior cruciate ligament reconstruction. A potential disadvantage of hamstring autograft for anterior cruciate ligament reconstruction is the inherent variability in graft diameter. Multiple studies have shown increased revision rates when using an undersized hamstring graft. Using an EndoButton (Smith & Nephew, Andover, MA) for femoral tunnel fixation, we convert a standard quadrupled hamstring graft into a 5-strand graft by creating 3 equal strands of the typically larger semitendinosus combined with a double-stranded gracilis. This technique may help alleviate some surgeon reluctance to use a hamstring graft by providing an intraoperative “bailout” option for an unexpectedly small tendon. On the basis of current data, increasing the diameter of the graft in these situations may decrease revision rates.

Lavery, Kyle P.; Rasmussen, Jeffrey F.; Dhawan, Aman

2014-01-01

67

Current recommendations for anterior cruciate ligament bracing: when to use.  

PubMed

Braces are often used during various stages of recovery from an anterior cruciate ligament tear despite there being sparse definitive research supporting their use. This article reviews the literature on brace use for patients with anterior cruciate ligament tears in order to provide a guide for clinicians. There is evidence to support immediate postoperative bracing, with the goals of maintaining full extension and decreasing effusion. There may be a psychological benefit for its use in return to sport; however, this should be weighed against decreased performance. In the context of modern graft-fixation techniques and early mobilization protocols, empiric functional brace prescription is not required for successful long-term clinical outcomes and return to sport. PMID:23445858

Masini, Brendan D; Owens, Brett D

2013-02-01

68

Updates in biological therapies for knee injuries: anterior cruciate ligament.  

PubMed

There have been many advances in anterior cruciate ligament reconstruction (ACLR) techniques incorporating biological treatment. The aim of this review is to discuss the recent contributions that may enlighten our understanding of biological therapies for anterior cruciate ligament (ACL) injuries and improve management decisions involving these enhancement options. Three main biological procedures will be analyzed: bio-enhanced ACL repair, bio-enhanced ACLR scrutinized under the four basic principles of tissue engineering (scaffolds, cell sources, growth factors/cytokines including platelet-rich plasma, and mechanical stimuli), and remnant-preserving ACLR. There is controversial information regarding remnant-preserving ACLR, since different procedures are grouped under the same designation. A new definition for remnant-preserving ACLR surgery is proposed, dividing it into its three major procedures (selective bundle augmentation, augmentation, and nonfunctional remnant preservation); also, an ACL lesion pattern classification and a treatment algorithm, which will hopefully standardize these terms and procedures for future studies, are presented. PMID:25070265

da Silveira Franciozi, Carlos Eduardo; Ingham, Sheila Jean McNeill; Gracitelli, Guilherme Conforto; Luzo, Marcus Vinicius Malheiros; Fu, Freddie H; Abdalla, Rene Jorge

2014-09-01

69

Anterior cruciate ligament reconstruction in men and women  

Microsoft Academic Search

Purpose: Recent studies have shown that female athletes suffer a higher incidence of anterior cruciate ligament (ACL) tears than comparable male athletes. The purpose of this study was to evaluate the effect gender has on outcome in ACL reconstruction using bone–patellar tendon–bone autograft. Type of Study: Retrospective case review and outcome study. Methods: A retrospective review of a single surgeon’s

James D. Ferrari; Bernard R. Bach; Charles A. Bush-Joseph; Thomas Wang; John Bojchuk

2001-01-01

70

Evidence-based rehabilitation following anterior cruciate ligament reconstruction  

Microsoft Academic Search

Following a bone-patellar tendon-bone autograft (BPTB) or four-stranded semitendinosus\\/gracilis tendons autograft (ST\\/G) anterior\\u000a cruciate ligament (ACL) reconstruction, the speed and safety with which an athlete returns to sports (or regains the pre-injury\\u000a level of function) depends on the rehabilitation protocol. Considering the large differences in clinical and outpatient protocols,\\u000a there is no consensus regarding the content of such a rehabilitation

S. van Grinsven; R. E. H. van Cingel; C. J. M. Holla; C. J. M. van Loon

2010-01-01

71

Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose  Patients presenting anterior cruciate ligament (ACL) deficiency and isolated osteoarthritis of the medial compartment are\\u000a treated either with biplanar osteotomy or with total knee arthroplasty (TKA). However, these patients between the forties\\u000a and fifties are often very active in daily life and feel limited due to their knee. In order to follow the idea of preserving\\u000a as much as possible

Marco Tinius; Pierre Hepp; Roland Becker

72

Rupture of the anterior cruciate ligament diagnosed by computertomography  

Microsoft Academic Search

Computertomography (CAT-scan) was used to examine 87 patients with a clinical differential diagnosis of a torn anterior cruciate\\u000a ligament (ACL), a torn meniscus or hemarthrosis. All joints were examined in slight flexion and no contrast medium was used.\\u000a By CAT-scan the ACL was found to be intact in 44, but torn in 43 patients. These findings were monitored by arthroscopy

N. Schwarz; K. Höcker; E. Tipold; W. Zechner

1993-01-01

73

(iii) What's new in anterior cruciate ligament surgery?  

Microsoft Academic Search

Anterior cruciate ligament (ACL) injury is relatively common. There is increasing awareness of the normal anatomy of the ACL and the need for reconstruction to replicate the normal anatomy. The ACL may be reconstructed as a single bundle or as a double bundle with restoration of the antero-medial and postero-lateral bundles. The postero-lateral bundle is most effective in providing stability

Andrew Unwin

2010-01-01

74

[Injuries of the anterior cruciate ligament in athletes].  

PubMed

Anterior cruciate ligament ruptures represent serious injuries for athletes which are often associated with accompanying injuries and lead to relevant kinematic alterations in the femorotibial roll-glide mechanism of the knee joint. Instability resulting in recurrent giving way events, as well as instability-related meniscal and cartilage lesions can cause functional long-term impairment that may limit the athlete's career. Anterior cruciate ligament replacement is therefore considered to be the gold standard for recovery of physical performance and to prevent secondary meniscal and cartilage damage. Continuous changes in the reconstruction of the anterior cruciate ligament have led to a variety of different methods, including graft choice, fixation devices and surgical techniques, which support the consideration of individual requirements of the athlete as well as sport-specific aspects. One of the main factors for restoring stability and the physiological kinematic roll-glide mechanism of the knee is an anatomical tunnel placement as well as a stable graft fixation in the tibia and femur. By achieving of these fundamental technical requirements an early functional rehabilitation and accelerated recovery of neuromuscular skills, strength and coordination can be achieved, so that an early return to sport activities is possible. PMID:25225041

Shafizadeh, S; Schneider, M M; Bouillon, B

2014-10-01

75

Bone tunnel enlargement on anterior cruciate ligament reconstruction  

PubMed Central

Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study. PMID:25328430

Leonardi, Adriano Barros de Aguiar; Duarte, Aires; Severino, Nilson Roberto

2014-01-01

76

Arthroscopic Augmentation With Subscapularis Tendon in Anterior Shoulder Instability With Capsulolabral Deficiency  

PubMed Central

The treatment of chronic shoulder instability with poor quality of the anterior capsulolabral tissue is still controversial. In these cases the Latarjet procedure is certainly more effective in preventing recurrence than an arthroscopic capsular repair. However, several studies have reported a variety of severe complications related to the Latarjet procedure because of the use of bone augmentation and hardware implantation; moreover, the arthroscopic version of the Latarjet procedure is technically difficult and potentially dangerous because of the proximity of neurovascular structures. The aim of this report is to describe an innovative arthroscopic technique consisting of an augmentation of the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. In the absence of severe bone deficiency of the anterior glenoid edge, this procedure can minimize arthroscopic technique failures, restoring the anterior capsulolabral wall without any significant reduction of shoulder functionality. PMID:24266004

Maiotti, Marco; Massoni, Carlo

2013-01-01

77

Cost Analysis of Converting From Single-Bundle to Double-Bundle Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Recent studies comparing double-bundle anterior cruciate ligament reconstruction to single-bundle anterior cruciate ligament reconstruction have reported some biomechanical advantages but little or no short-term clinical benefit from the double-bundle technique. In the current healthcare environment, the potential economic implications of widespread conversion to a double-bundle anterior cruciate ligament reconstruction are an important consideration.Purpose: To determine the economic implications of

Robert H. Brophy; Rick W. Wright; Matthew J. Matava

2009-01-01

78

Double-stranded hamstring graft for anterior cruciate ligament reconstruction.  

PubMed

Current techniques for anterior cruciate ligament (ACL) reconstruction do not completely reproduce the anatomy and function of the ACL. They address only the anteromedial bundle and do not fully restore ACL function throughout the range of motion. Current grafts control anterior tibial subluxation near extension, but are less efficacious in providing rotatory stability. Recently, several authors have suggested reconstructing not just the anteromedial bundle but also the posterolateral bundle. This technical note describes a double-bundle ACL reconstruction using hamstring tendons routed through 2 tibial and 2 femoral independent tunnels. PMID:15483556

Bellier, Guy; Christel, Pascal; Colombet, Philippe; Djian, Patrick; Franceschi, Jean Pierre; Sbihi, Abdou

2004-10-01

79

Quadriceps protects the anterior cruciate ligament  

Microsoft Academic Search

The aim of this study is to show that the quadriceps is the primary muscular restraint to anterior tibial translation during closed kinetic chain activities such as running, jumping, walking, and standing. It is my hypothesis that the quadriceps vector is directed superiorly during open kinetic chain knee extension and inferiorly during closed kinetic chain knee extension. My methods involve

Marko Bodor

2001-01-01

80

Allograft anterior tibialis tendon with bioabsorbable interference screw fixation in anterior cruciate ligament reconstruction  

Microsoft Academic Search

For a variety of reasons, bone–patellar tendon–bone and Achilles tendon allografts have been used more commonly in anterior cruciate ligament reconstruction. Soft-tissue allografts used mainly are the semitendinosus, gracilis, and occasionally the quadriceps tendons. The anterior tibialis tendon is a thick, strong tendon that can be prepared with one doubling of the graft, has a large cross-sectional area, and has

David N. M. Caborn; Jeffrey B. Selby

2002-01-01

81

Does concomitant meniscectomy affect medium-term outcome of anterior cruciate ligament reconstruction? A preliminary report  

PubMed Central

Introduction Anterior cruciate ligament (ACL) injury is often accompanied by injuries of the menisci. In order to restore knee stability, anterior cruciate ligament reconstruction (ACLR) is performed, with meniscus surgery when needed. The purpose of this study was to assess the medium-term outcome of ACLR in subjects with and without concomitant meniscus tear and partial meniscectomy. Material and methods We prospectively studied 73 patients after arthroscopically assisted bone-patellar tendon-bone ACLR. Subjects were divided into two subgroups: those who had only ACLR (group A, 54 subjects with mean age 28, (SD 9)) and those who underwent both ACLR and concomitant partial meniscectomy (group B, 19 subjects, mean age 32 [11]). Subjects completed a disease-specific questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS), preoperatively and at a minimum follow-up of 1 year. Results No differences in mean scores between group A and B were observed either preoperatively or at follow-up. We found a significant change in mean score in the KOOS subscale QoL in group A following ACLR (? = 9 points, p = 0.039). Most subjects improved in the KOOS subscales Sports and Recreation and QoL in both group A (59 and 52% respectively) and B (63 and 47% respectively). Eight subjects (15%) from group A and 1 (5%) from group B fulfilled criteria of functional recovery. Criteria of treatment failure were fulfilled in 17 subjects (32%) from A and 4 (21%) from group B. Conclusions Patients undergoing ACLR with partial meniscectomy had a similar medium-term outcome compared to individuals with ACL tear alone.

Keska, Rafal; Witonski, Dariusz

2014-01-01

82

Tuberculum Intercondylare Tibiae Tertium as a Predictive Factor for Anterior Cruciate Ligament Injury  

Microsoft Academic Search

The aim of this study was to assess the presence of tuberculum intercondylare tibiae tertium, also known as Parsons' knob, and to determine its prominence. Knee radiographs of 171 patients operated on for anterior cruciate ligament injury were examined. The control group included 120 sex- and age-matched patients who underwent orthopaedic examination for knee pain, in whom anterior cruciate ligament

Marko Pe?ina; Irenko Bajok; Hrvoje Ivan Pe?ina

2001-01-01

83

Acute anterior cruciate ligament injury and augmented repairExperimental studies  

Microsoft Academic Search

Eleven dogs underwent transection of the anterior cruciate ligament at the femoral origin of the stifle (knee) joint. The anterior cruciate ligaments were repaired in a conventional manner and augmented by transferring the medial one-third of the patellar tendon and inserting it into the lateral femoral condyle. The repairs were evaluated either 4 or 8 months postoperatively. All repaired and

H. Edward Cabaud; John A. Feagin; William G. Rodkey

1980-01-01

84

The effect of the walking speed on the stability of the anterior cruciate ligament deficient knee  

Microsoft Academic Search

Background. The reasons behind the development of future pathology in individuals with anterior cruciate ligament deficiency are unknown. This is due to the lack of appropriate methods to assess functional dynamic knee stability. In this study, we investigated the effect of walking speed on the functional dynamic stability of the anterior cruciate ligament deficient knee. We defined functional dynamic stability

Nicholas Stergiou; Constantina Moraiti; Giannis Giakas; Stavros Ristanis; Anastasios D. Georgoulis

2004-01-01

85

Outcome of anterior cruciate ligament reconstruction with emphasis on sex-related differences.  

PubMed

The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using the four-strand semitendinosus-gracilis (ST/G) autograft in male (n=141) vs female (n=103) patients. The patients were operated on between 1996 and 2005, using interference screw fixation and drilling the femoral tunnel through the anteromedial portal. The pre-operative assessments and demographics, apart from age (males 29 years, females 26 years; P=0.02), were comparable at the time of surgery. At 25 (23-36) months post-operatively, no significant differences were found between the study groups in terms of anterior side-to-side knee laxity, manual Lachman test, Tegner activity level, Lysholm knee score, range of motion or donor-site morbidity. Both study groups improved significantly in most clinical assessments and functional scores compared with their pre-operative values. Two years after ACL reconstruction using ST/G autografts, there were no significant differences between male and female patients in terms of clinical outcome or functional scores. PMID:21518011

Ahldén, M; Sernert, N; Karlsson, J; Kartus, J

2012-10-01

86

ARTROSKOPSKO ZDRAVLJENJE ANTERIORNE UTESNITVE V ZGORNJEM SKO?NEM SKLEPU ARTHROSCOPIC TREATMENT OF ANTERIOR IMPINGEMENT IN THE ANKLE  

Microsoft Academic Search

Background. Anterior soft tissue impingement is a common cause of chronic pain in the ankle. The preferred method of operative treatment is an arthroscopic excision of hypertrophic fibrous and synovial tissue in the anterior part of the ankle joint. Methods. We present the results of arthroscopic treatment of anterior ankle impingement in group of 14 patients. Results. Subjective improvement after

Martin Mikek; Mohsen Hussein

87

Preventing Anterior Cruciate Ligament Failure During Impact Compression by Restraining Anterior Tibial Translation or Axial Tibial Rotation  

Microsoft Academic Search

Anterior cruciate ligament injury is highly prevalent in activities that involve large and rapid landing impact loads. We\\u000a hypothesize that restraining anterior tibial translation or axial tibial rotation can prevent the anterior cruciate ligament\\u000a from failing at the range of peak compressive load that can induce ligament failure when both factors are unrestrained. Sixteen\\u000a porcine knee specimens were mounted onto

C. H. Yeow; R. S. Khan; Peter V. S. Lee; James C. H. Goh

88

Gender Differences in Anterior Cruciate Ligament Injury Vary With ActivityEpidemiology of Anterior Cruciate Ligament Injuries in a Young, Athletic Population  

Microsoft Academic Search

Background: Previous studies have shown that women involved in similar activities as men are at increased risk for anterior cruciate ligament injuries.Hypothesis: The incidence rate of complete anterior cruciate ligament tears for men and women in our athletic, college-aged population is similar.Study Design: Descriptive epidemiology study.Methods: Students graduating in class years 1994 to 2003 at our institution who sustained complete

Sally B. Mountcastle; Matthew Posner; John F. Kragh; Dean C. Taylor

2007-01-01

89

An arthroscopic bone graft procedure for treating anterior–inferior glenohumeral instability  

Microsoft Academic Search

The purpose of this study is twofold: to present an arthroscopic method for treating anterior–inferior glenohumeral instability,\\u000a and to evaluate its feasibility in a cadaveric model. This arthroscopic technique was performed in ten fresh frozen cadaver\\u000a shoulder specimens. Quality of the results following the procedure were evaluated subjectively by assessing how the bone block\\u000a graft was placed respect glenoid rim.

E. Taverna; P. Golanò; V. Pascale; F. Battistella

2008-01-01

90

Arthroscopic studies of variants of the anterior horn of the medial meniscus  

Microsoft Academic Search

The objective of this study was to arthroscopically analyse the morphology and dynamics of variants of the anterior horn of the medial meniscus of the knee (VAMM) and to then consider the pathological significance of these variants. VAMM was defined as knees in which the anterior horn of the medial meniscus is not attached to the tibia. Between April 1992

Yasumitsu Ohkoshi; Tatsuto Takeuchi; Chiharu Inoue; Tomoyuki Hashimoto; Keiichi Shigenobu; Shigeru Yamane

1997-01-01

91

Knee extension and flexion: MR delineation of normal and torn anterior cruciate ligaments  

SciTech Connect

Our goal was to assess the effect of joint position of semiflexed and extended knees in MR delineation of the anterior cruciate ligament (ACL). With a mobile knee brace and a flexible surface coil, the knee joint was either fully extended or bent to a semiflexed position (average 45{degrees} of flexion) within the magnet bore. Sets of oblique sagittal MR images were obtained for both extended and flexed knee positions. Thirty-two knees with intact ACLs and 43 knees with arthroscopically proven ACL tears were evaluated. Two observers compared paired MR images of both extended and flexed positions and rated them by a relative three point scale. Anatomic correlation in MR images was obtained by a cadaveric knee with incremental flexion. The MR images of flexed knees were more useful than of extended knees in 53% of the case reviews of femoral attachments and 36% of reviews of midportions of normal ACLs. Compared with knee extensions, the MR images for knee flexion provided better clarity in 48% of reviews of disrupted sites and 52% of residual bundles of torn ACLs. Normal ACL appeared taut in the knee extension and lax in semiflexion. Compared with MR images of knees in extension, MR images of knees in flexion more clearly delineate the femoral side of the ligament with wider space under the intercondylar roof and with decreased volume-averaging artifacts, providing superior visualization of normal and torn ACLs. 13 refs., 7 figs., 1 tab.

Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Anno, Izumi; Itai, Yuji [Univ. of Tsukuba, Ibaraki (Japan)] [Univ. of Tsukuba, Ibaraki (Japan)

1996-03-01

92

Reconstruction of anterior cruciate ligaments with bone-patellar tendon-bone and achilles tendon allografts.  

PubMed

Two hundred fourteen patients had anterior cruciate ligament (ACL) reconstructions performed with banked freeze-dried or frozen allografts using an arthroscopic-assisted technique. Of these, 181 patients were available for follow-up testing and examination. Minimum follow-up time was four years (average, 57 months). All patients were evaluated by using KT-1000 arthrometer and Biodex testing as well as by physical examination. Final results were rated as satisfactory or unsatisfactory by using a modified Feagin knee scoring scale. Patients who were classified as good or excellent were considered to have satisfactory results. Those who were classified as fair or poor were considered to have unsatisfactory results. During the course of the study, 79% of the patients had satisfactory results. The percentage of patients with satisfactory results increased as the study progressed. The surgical technique was modified as new biomechanical principles were applied to ACL reconstruction. Rehabilitation of the patients was also progressively changed from conservative to aggressive. The authors attribute the improvement from 67% of patients with satisfactory results in 1984 to 85% in 1988 at least partially to these modifications. It was concluded that either frozen or freeze-dried aseptically excised and processed bone-patellar tendon-bone and Achilles tendon allografts can serve adequately for the reconstruction of ACLs. Complications may be reduced and clinical end results improved by adherence to an exact, reproducible surgical technique and an aggressive rehabilitation regimen. PMID:8194256

Levitt, R L; Malinin, T; Posada, A; Michalow, A

1994-06-01

93

Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation  

PubMed Central

Background: Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1 year, the anteroposterior side to side translation difference (KT-1000 manual maximum) showed mean improvement from 5.1 mm ± 1.5 preoperatively to 1.6 mm ± 1.2 (P < 0.001) postoperatively. The Lysholm score too showed statistically significant (P < 0.001) improvement from 52.4 ± 15.2 (range: 32-76) preoperatively to a postoperative score of 89.1 ± 3.2 (range 67-100). According to the IKDC score 90% patients had normal results (Category A and B). The AM femoral tunnel initial posterior blow out was seen in 4 patients and confluence in the intraarticular part of the femoral tunnels was seen in 6 patients intraoperatively. The quadriceps strength on isokinetic testing had an average deficit of 10.3% while the hamstrings had a 5.2% deficit at the end of 1 year as compared with the normal side. Conclusion: Our study revealed that the DBACL reconstruction using crosspin fixation for AM bundle and aperture fixation for PL bundle on the femoral side resulted in significant improvement in KT 1000, Lysholm and IKDC scores. PMID:24600062

Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Modi, Prashant; Chaudhary, Deepak

2014-01-01

94

[Return to sport after anterior cruciate ligament reconstruction].  

PubMed

Despite continuous advances in techniques for anterior cruciate ligament reconstruction (ACLR), return to play (RTP) after surgery remains a challenge. More than one-third of the patients are unable to return to their preinjury sport level, for most because of a fear to sustain another injury. And when a RTP is attempted, up to 20% will tear their graft and a similar % will sustain an ACL tear on the opposite side. We believe that these failures result from an incomplete recovery. Based on a literature review and on our experience, we suggest 6 objective criteria to allow a safer RTP. They rely on laxity, strength, neuromuscular function, and psychological evaluations. Rehabilitation after ACLR should focus on the deficits identified by these tests and on they specific needs of the sport that the athlete plans to return to. PMID:23971328

Martin, R; Gard, S; Besson, C; Ménétrey, J

2013-07-17

95

Anterior cruciate ligament tear prevention in the female athlete.  

PubMed

This paper examines the effectiveness of implementing neuromuscular and proprioceptive training programs in female athletes and their ability to decrease the incidence of anterior cruciate ligament (ACL) injury. The relationship of sex, age, and training on the incidence of ACL injury is pivotal in developing a comprehensive neuromuscular and proprioceptive training program to decrease ACL injuries occurring in female athletes. Based on the 2-year results, ACL incidence has remained consistently lower in the intervention group versus the control group. A prophylactic neuromuscular and proprioceptive training program may have a direct benefit in decreasing the number of ACL injuries incurred by female athletes. This research foundation endorses further epidemiologic and biomechanic studies to determine the exact mechanism of ACL injury and the most effective intervention that will effectively decrease ACL injuries in this high-risk population. PMID:16282037

Silvers, Holly J; Giza, Eric R; Mandelbaum, Bert R

2005-12-01

96

Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities  

Microsoft Academic Search

The functional anatomy of the anterior cruciate ligament was studied in 18 freshly amputated specimens. The cruciates were observed in the extremes of flexion and extension, and in midposition in simulated weight-bearing and nonweight-bearing conditions. Five femoral shafts were split longitudinally so that the femoral and tibial attachments of the ligament could be inspected. The findings indicated that (1) the

Lyle A. Norwood; Mervyn J. Cross

1979-01-01

97

A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.  

ERIC Educational Resources Information Center

The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

Weesner, Carol L.; And Others

1986-01-01

98

Primary Repair Combined With Bone Marrow Stimulation in Acute Anterior Cruciate Ligament LesionsResults in a Group of Athletes  

Microsoft Academic Search

Background: The anterior cruciate ligament has been shown to have poor healing ability, and reconstruction is the standard treatment.Hypothesis: Primary anterior cruciate ligament repair combined with bone marrow stimulation could restore stability and function in athletes with acute anterior cruciate ligament incomplete tears.Study Design: Case series; Level of evidence, 4.Methods: Among a group of 99 patients with clinically diagnosed anterior

Alberto Gobbi; Lyndon Bathan; Lorenzo Boldrini

2009-01-01

99

Arthroscopic posterior cruciate ligament reconstruction in a skeletally immature patient: a new technique with case report.  

PubMed

Pediatric intrasubstance posterior cruciate ligament (PCL) injuries are rare but present a significant treatment challenge. Untreated instability may lead to further knee injury, including meniscal or chondral damage. Surgical intervention risks damage to the physis, growth arrest, and angular deformity. We present the case of a skeletally immature 11-year-old boy with a high-grade intrasubstance PCL injury reconstructed using an all-arthroscopic tibial inlay technique modified to minimize risk of physeal injury. The femoral tunnels were placed entirely within the epiphysis, and the tibial physis was minimally crossed with a small drill hole and suture material. At 17 months' follow up, the patient had returned to full activity, including sports. He had a grade 1 posterior drawer and no posterior sag. Radiographs showed no degenerative changes. Both the proximal tibial and distal femoral physes were widely patent with no angular deformity. The patient had a 1-cm leg length discrepancy, with the operative limb being longer. This technical note with a case report describes a novel physeal-sparing reconstruction of the PCL in a pediatric patient with open physes. PMID:20362839

Bovid, Karen M; Salata, Michael J; Vander Have, Kelly L; Sekiya, Jon K

2010-04-01

100

Estimation of in-vivo forces within Anterior Cruciate Ligament in response to increased weightbearing  

E-print Network

The knowledge of Anterior Cruciate Ligament (ACL) forces in-vivo is instrumental for understanding ACL injury mechanisms and for improvement of surgical ACL reconstruction. The goal of this thesis was to develop and implement ...

Hosseini, Ali, M. Eng. Massachusetts Institute of Technology

2010-01-01

101

In-vivo Anterior Cruciate Ligament Elongation in Response to Axial Tibial Loads  

E-print Network

Background: The knowledge of in vivo anterior cruciate ligament (ACL) deformation is fundamental for understanding ACL injury mechanisms and for improving surgical reconstruction of the injured ACL. This study investigated ...

Gill, Thomas J.

102

Tissue engineering the anterior cruciate ligament : a regenerative medicine approach in orthopaedic surgery  

E-print Network

Anterior cruciate ligament (ACL) injuries affect over 200,000 Americans yearly, and many occur in young athletes. Current treatment options include tendon autografts and cadaveric allografts. However, these approaches often ...

Canseco, José Antoni

2013-01-01

103

Osseous injury associated with acute tears of the anterior cruciate ligament  

Microsoft Academic Search

Multiplanar spin-echo magnetic resonance imaging was performed on 54 patients with acute complete anterior cruciate ligament tears. Imaging was done within 45 days of index anterior cruciate ligament injury. Spin- echo T1- and T2-weighted images were used to deter mine the lesion morphology and location. Only the T2- weighted sagittal images were used for the incidence assessment; T2-weighted spin-echo imaging

Kevin P. Speer; Charles E. Spritzer; Frank H. Bassett; John A. Feagin; William E. Garrett

1992-01-01

104

The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Objective. To determine the effect of quadriceps strength and joint stability on gait patterns after anterior cruciate ligament injury and reconstruction.Design. Cross-sectional comparative study in which four groups underwent motion analysis with surface electromyography.Background. Individuals following anterior cruciate ligament rupture often demonstrate reduced knee angles and moments during the early stance phase of gait. Alterations in gait can neither be

Michael Lewek; Katherine Rudolph; Michael Axe; Lynn Snyder-Mackler

2002-01-01

105

Proprioceptive comparison of allograft and autograft anterior cruciate ligament reconstructions.  

PubMed

The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia. PMID:17828525

Ozenci, A Merter; Inanmaz, Erkan; Ozcanli, Haluk; Soyuncu, Yetkin; Samanci, Nehir; Dagseven, Tufan; Balci, Nilüfer; Gur, Semih

2007-12-01

106

Longitudinal Tear of the Medial Meniscus Posterior Horn in the Anterior Cruciate Ligament–Deficient Knee Significantly Influences Anterior Stability  

Microsoft Academic Search

Background: Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees.Hypothesis: An MMPH tear in an ACL-deficient knee increases the anterior-posterior

Jin Hwan Ahn; Tae Soo Bae; Ki-Ser Kang; Soo Yong Kang; Sang Hak Lee

2011-01-01

107

A modified repair for the anterior cruciate ligament deficient knee.  

PubMed Central

A retrospective analysis of 48 sportsmen and women from an original series of 76 consecutive patients who had undergone a modified McIntosh repair was carried out to establish whether or not the procedure could provide a satisfactory recovery and return to previous ability. The type and level of sport before injury was compared with that after operation. Symptoms of pain and giving way, and examination findings of pivot shift, and Lachman's test were compared before and after operation. Of the 48 patients assessed, 28 (58%) returned to full sporting capacity; 17 (35%) patients were participating in different sports or lower levels of their previous sports, and three patients did not participate in any sport. The more severely symptomatic knees did not perform so well after operation. The degree of preoperative anterior draw and Lachman's test did not influence the final result and the pivot shift, present in all before operation, was abolished in all but one case, which remained badly symptomatic. Concurrent meniscal injury or medial or lateral laxity did not influence return to sport once a full postoperative recovery was made. No deterioration was noticed in the level of sporting ability achieved thereafter. In this study it has been shown that the modified McIntosh repair is a swift extra-articular reconstruction for the anterior cruciate ligament deficient knee, which is less elaborate than previously described Ellison and McIntosh procedures, and which has produced a comparable result. PMID:1490218

Holland, J P

1992-01-01

108

Correlation between trochlear dysplasia and anterior cruciate ligament injury.  

PubMed

PURPOSE. To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury METHODS. Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/ disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated. RESULTS. 58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76-1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non-type-A knees (p=0.023). CONCLUSION. Dejour type-A trochlear dysplasia was associated with ACL injuries. PMID:24014781

Botchu, Rajesh; Obaid, Haron; Rennie, W J

2013-08-01

109

A new bicortical tibial fixation technique in anterior cruciate ligament reconstruction with quadruple hamstring graft.  

PubMed

We report a prospective series of 101 patients receiving a four-strand semitendinosus-gracilis autograft for anterior cruciate ligament reconstruction using a new bicortical tibial fixation technique with bioabsorbable interference screws. Patients (average age 32 years) were operated on between November 1997 and Mai 1998, and follow-up was at least 12 months postoperatively. The evaluation consisted of history, clinical examination, IKDC score, Cincinnati Knee Score, KT-1000 testing, standardized radiography and magnetic resonance imaging. One hundred patients were available for follow-up. There were two traumatic reruptures 6 and 11 months postoperatively. By IKDC score 87 patients were in groups A and B, 12 in group C, and 2 with a rerupture in group D. Mean Cincinnati Knee Score was 82 (range 46-100), KT-1000 manual maximum at follow-up showed an average difference of 1.7 mm between the sides. Full extension was rapidly achieved in all cases, and flexion averaged 135 degrees . Considering the enlargement caused by the bioabsorbable interference screws, the incidence of tunnel widening was 6.6% on the femoral side and 1.7% on the tibial side. Tunnel widening did not affect the clinical results. Three patients experienced an effusion after more than 6 months postoperatively. There was one infection, which settled without functional impairment after early arthroscopic lavage and intravenous antibiotics. Otherwise no complications occurred. The described technique for anterior cruciate ligament reconstruction combines the advantage of anatomical graft position with sufficient graft fixation. A short intra-articular graft construct with a strong tendon to bone interface was created. Clinically, 87% of patients had a normal or nearly normal IKDC score at follow-up. Magnetic resonance imaging revealed a considerable increase in tunnel area caused by the insertion of the interference screws. On the other hand, the development of a "fibrous interzone" between the graft and the bone tunnel was prevented in most cases. At short-term follow-up the bicortical tibial fixation proved to be efficient even with an aggressive rehabilitation program. PMID:10975262

Buelow, J U; Siebold, R; Ellermann, A

2000-01-01

110

Arthroscopically assisted quadriceps double-bundle tibial inlay posterior cruciate ligament reconstruction: an analysis of techniques and a safe operative approach to the popliteal fossa  

Microsoft Academic Search

The arthroscopically assisted posterior cruciate ligament tibial inlay technique, frequently used in athletic individuals and in revision cases, requires a thorough and comprehensive understanding of posterior knee anatomy. Importantly, variations in the posterior vascular anatomy may be encountered. A safe and methodical posteromedial approach in a layered fashion to achieve proper and safe tibial inlay graft placement and fixation is

Frank R Noyes; Michael J Medvecky; Manoj Bhargava

2003-01-01

111

Rotational laxity of the Knee following reconstruction of the Anterior Cruciate Ligament using single vs double-bundle surgery.  

E-print Network

??Knee laxity following anterior cruciate ligament (ACL) injury may lead to long-term joint degeneration causing osteoarthritis. Although traditional surgical techniques are sufficient in providing anteriorposterior… (more)

Hemmerich, Andrea

2009-01-01

112

A Proposal for a New Tibial Guide System for Posterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Posterior cruciate ligament reconstruction is always a challenge to the orthopaedic surgeon. It is difficult when the anterior cruciate ligament (ACL) is intact. We propose a new guide system through the posteromedial portal, avoiding ACL damage. The arthroscope is inserted anteromedially (30°), and anterolateral portals are used for instruments to confirm the diagnosis and inspect the joint to search for

Rene Jorge Abdalla; André Valente Pacagnan; Hugo Alexandre Guimarães Loyola; Moisés Cohen; Gilberto Luís Camanho; Andrea Forgas

2007-01-01

113

Clinical results and motion analysis following arthroscopic anterior stabilization of the shoulder using bioknotless anchors  

PubMed Central

Purpose: Traumatic anterior dislocation of the shoulder is a common occurrence increasingly being treated arthroscopically. This study aims to determine the outcome of arthroscopic anterior stabilization using bioknotless anchors and analyze the motion in a subset of these patients. Materials and Methods: The outcome of 20 patients who underwent arthroscopic anterior stabilization using the bioknotless system was studied (average follow-up 26 months). Four of these patients underwent motion analysis of their shoulder pre- and post-operatively. Results: 15% were dissatisfied following surgery and the recurrence of instability was also 15%. Those who were dissatisfied or suffered recurrent symptoms had statistically significant lower constant scores at the final follow up. Pre-operative motion analysis showed a disordered rhythm of shoulder rotation which was corrected following surgery with minimal loss of range of motion. Conclusions: Our success rate was comparable to similar arthroscopic techniques and results published in the literature. Patient satisfaction depended more on return to usual activities than recurrence of symptoms. There was very little reduction in range of movement following surgery and the rhythm of shoulder motion, particularly external rotation in abduction was improved. Level of Evidence: Four retrospective series. PMID:21072146

Cooke, Stephen; Ennis, Owain; Majeed, Haroon; Rahmatalla, Aziz; Kathuria, Vinod; Wade, Roger

2010-01-01

114

Radiation risk from fluoroscopically-assisted anterior cruciate ligament reconstruction  

PubMed Central

INTRODUCTION Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients. PATIENTS AND METHODS Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient. RESULTS The median age of 58 patients included in data analysis was 28 years (range, 14–52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 ± 0.0029 Gy. The mean ED was 0.001 ± 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%. CONCLUSIONS Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure. PMID:20501019

Chitnavis, JP; Karthikesaligam, A; Macdonald, A; Brown, C

2010-01-01

115

Treating Anterior Cruciate Ligament Tears in Skeletally Immature Patients  

PubMed Central

Purpose To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. Methods A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than six months of follow-up were excluded. Study quality was assessed and data were collected on clinical outcome, growth disturbance, and secondary joint damage. Results We identified 48 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence for growth disturbance, yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. Conclusions The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. While physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. Level of Evidence Level IV, systematic review of Level II, III, and IV studies. PMID:21552340

Vavken, Patrick; Murray, Martha M

2011-01-01

116

Anterior cruciate ligament injury: diagnosis, management, and prevention.  

PubMed

There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. Most ACL tears occur from noncontact injuries. Women experience ACL tears up to nine times more often than men. Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. The Lachman test is the most accurate test for detecting an ACL tear. Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. It can also identify concomitant meniscal injury, collateral ligament tear, and bone contusions. Treatment consists of conservative management or surgical intervention, with the latter being the better option for patients who want to return to a high level of activity. Patients who undergo surgery must commit to appropriate rehabilitation for the best outcome. Long-term sequelae of ACL injury include knee osteoarthritis in up to 90 percent of patients. Primary prevention of ACL injury includes specific proprioceptive and neuromuscular training exercises to improve knee stability. PMID:20949884

Cimino, Francesca; Volk, Bradford Scott; Setter, Don

2010-10-15

117

Anterior cruciate ligament injuries: diagnosis, treatment, and prevention.  

PubMed

The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion. ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee. Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls. This report outlines the current state of knowledge on epidemiology, diagnosis, treatment, and prevention of ACL injuries in children and adolescents. PMID:24777218

LaBella, Cynthia R; Hennrikus, William; Hewett, Timothy E

2014-05-01

118

Behavior of sutures used in anterior cruciate ligament reconstructive surgery.  

PubMed

This study was performed to determine the material properties of sutures commonly used in orthopedic surgery in order to allow selection of the most appropriate one for securing a hamstring or quadriceps tendon graft in anterior cruciate ligament (ACL) reconstruction. Three suture materials (number 5 Ticron, number 5 Ethibond, and 5 mm Mersilene tape) were tested. The ultimate tensile load (UTL) with and without a knot, modulus of elasticity, effect of conditioning on the behavior of the suture, and plastic deformation were determined for each suture. Prior conditioning significantly improved the plastic deformation characteristics of all three sutures. Mersilene possessed the highest UTL both with and without knots, and its plastic deformation was significantly lower than that of Ticron or Ethibond. We feel that these characteristics make it the best suture for use in securing hamstring or tendon grafts in ACL surgery. Because of the high UTL achieved by Mersilene tape in the knotted surgical loop construct (nearly 500 N), it may be possible to achieve fixation integrity approaching that of interference fixation with bone blocks. PMID:8884727

Spencer, E E; Chissell, H R; Spang, J T; Feagin, J A; Manoff, E M; Rohatgi, S D

1996-01-01

119

Basic science of anterior cruciate ligament injury and repair  

PubMed Central

Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair. Cite this article: Bone Joint Res 2014;3:20–31. PMID:24497504

Kiapour, A. M.; Murray, M. M.

2014-01-01

120

Anterior cruciate ligament insufficiency: does delay in index surgery affect outcome in recreational athletes  

PubMed Central

The aim of the study was to see if delay in anterior cruciate ligament (ACL) reconstruction affects post-reconstruction outcome in recreational athletes. Sixty-two recreational athletes who had arthroscopic ACL reconstructions using quadruple hamstring grafts between 1997 and 2000 were retrospectively evaluated. Patients with less than 2 years’ follow-up, those with multi-ligament injuries, reconstructions for previous failed repairs, those whose injury date was unknown, those with pre-injury Tegner activity level greater than 7 (competitive athletes) and those lost to follow-up were all excluded. Forty-six patients (38 males) were entered. The mean follow up was 38 months and the mean time from injury to index ACL reconstruction was 27 months. Apart from two revisions there were no other significant complications. Forty-one (89%) patients were evaluated in a review clinic. There was a significant improvement in the post-reconstruction Lysholm scores and an improvement in the Tegner scores. The Spearman’s correlation coefficient between postoperative Lysholm score and the delay until surgery was ?0.18 and the correlation coefficient between postoperative Tegner scores and the delay until surgery was 0.14. Thirty-five patients returned to sporting activity. Thirty-seven rated their knee as being normal or nearly normal and 35 said that their knee function was as they had expected it to be. Late ACL reconstruction does not adversely affect the outcome in recreational athletes. ACL reconstruction should be offered to these patients as there is a significant improvement in the knee function and patients are satisfied with the results. PMID:16501976

Godsiff, S. P.; Mulay, S.; Joshi, M.

2006-01-01

121

Displaced bucket handle tears of the medial meniscus masking anterior cruciate deficiency  

Microsoft Academic Search

Traditionally, anterior cruciate ligament (ACL) injuries have been difficult to diagnose in the Casualty Department. Studies have shown that the anterior drawer test has a poor sensitivity both in acute and chronic ACL deficient knees [4, 6, 9]; thus, more emphasis has been placed on the pivot shift and Lachman tests [3]. We report four cases of proven ACL rupture

K. C. Kong; M. R. Hamlet; T. Peckham; M. A. S. Mowbray

1994-01-01

122

Review on tension in the natural and reconstructed anterior cruciate ligament  

Microsoft Academic Search

This article reviews the methodology and results of published studies concerned with tension in the natural and reconstructed anterior cruciate ligament (ACL). This also includes studies of fiber length changes with knee motion and the relationships between graft tunnel placements and isometricity. Little work has been done in vivo: in humans, length changes of the anterior ACL fibers have been

H. N. Andersen; A. A. Amis

1994-01-01

123

Multiple risk factors related to familial predisposition to anterior cruciate ligament injury: fraternal twin sisters with anterior cruciate ligament ruptures  

PubMed Central

Objective A multifactorial combination of predictors may increase anterior cruciate ligament (ACL) injury risk in athletes. The objective of this twin study was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury. Methods Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using three-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity using a modified Beighton–Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction. Results Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings. Conclusions Prescreened mature female twins that subsequently experienced ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width. PMID:19158132

Hewett, T E; Lynch, T R; Myer, G D; Ford, K R; Gwin, R C; Heidt, R S

2014-01-01

124

Sex, Collagen Expression, and Anterior Cruciate Ligament Strength in Rats  

PubMed Central

Abstract Context: Sex-specific responses to steroid sex hormones have been suggested as a potential cause for the disparate anterior cruciate ligament (ACL) injury rates between male and female athletes. Type 1 collagen (T1C) and type 3 collagen (T3C) are crucial structural components that define the ligament's ability to withstand tensile loads. Messenger RNA (mRNA) is an important mediator of downstream collagen synthesis and remodeling, but the sex-specific mechanisms of collagen mRNA expression and ACL strength are unknown. Objective: To examine the influence of sex on T1C and T3C mRNA expression and mass-normalized stiffness and peak failure load in the ACLs of skeletally mature rats. Design: Observational study. Setting: Basic sciences and biomechanical testing laboratories. Patients or Other Participants: Nineteen 12-week-old male (n ?=? 9) and female (n ?=? 10) Sprague Dawley rats. Main Outcome Measure(s): We used real-time polymerase chain reaction to determine T1C and T3C mRNA expression and a hydraulic materials testing device to measure ACL stiffness and failure load. Nonparametric Wilcoxon rank sum tests were used to compare the groups. Results: Female rats had lower amounts of T3C mRNA expression and higher normalized ACL tangent stiffness and failure load than male rats. Conclusions: These findings suggest that sex-specific differences in T1C and T3C mRNA expression may play an important role in the downstream mechanical properties of the ACL. PMID:20064044

Romani, William A.; Langenberg, Patricia; Belkoff, Stephen M.

2010-01-01

125

Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes.  

PubMed

ACL reconstruction in adolescents undergoing or being beyond the final growth spurt can be performed as in adults without major concern of growth disturbance. Whereas for the young athlete with wide-open physis a lot of controversy still exists about the technical aspect of the procedure to minimise the risk of growth disturbance. Between 10/1997 and 10/2002 31 children graded Tanner stage 1 or 2 (median age 11 years) with an intraligamental rupture of the anterior cruciate ligament were enrolled. Seventeen patients with coexisting intraarticular damage (meniscus, osteochondral flake) underwent transphsyeal reconstruction of the ACL with the use of an autogenous semitendinosus tendon graft, whereas 14 patients without coexisting pathologies received a nonoperative regime. Growth disturbance, functional and radiographic outcome could be evaluated in 28 patients at a median of 70 months after initial treatment. No patient had clinical or radiological evidence for varus/valgus malalignment or leg length discrepancy. The mean of subsequent body growth within the study population was 20.3 cm. Patients operated on revealed significant (P < 0.05) better clinical (KT-1000 side-to-side difference, pivot shift) and functional results according to the IKDC (median, 95 vs. 87), Lysholm (median, 93 vs. 84) and the Tegner score. More than half of the conservatively treated patients (58%) had subsequent surgery due to persistent instability. Transphyseal reconstruction of intraligamental ACL ruptures with an autologous ST graft yielded superior clinical results if compared to a nonoperative treatment in immature prepubescent patients being Tanner stage 1 and 2. PMID:20130837

Streich, Nikolaus A; Barié, Alexander; Gotterbarm, Tobias; Keil, Maximilian; Schmitt, Holger

2010-11-01

126

Isokinetic Evaluation of Internal\\/External Tibial Rotation Strength after the Use of Hamstring Tendons for Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Evaluation of the knee after an anterior cruciate ligament reconstruction with the use of the semitendinosus and gracilis (hamstring) autografts has primarily focused on flexion and extension strength. The semitendinosus and gracilis muscles contribute to internal tibial rotation, and it has been suggested that harvest of these tendons for the purpose of an anterior cruciate ligament reconstruction contributes to

Tanya Armour; Lorie Forwell; Robert Litchfield; Alexandra Kirkley; Ned Amendola; Peter J. Fowler

2004-01-01

127

Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Birmingham TB, Kramer JF, Kirkley A. Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 2002;83:1472-5. Objectives: To investigate the effect of a knee brace on knee flexion and extension muscular strength of patients after anterior cruciate ligament (ACL) reconstruction and to evaluate whether the effect of the

Trevor B. Birmingham; John F. Kramer; Alexandra Kirkley

2002-01-01

128

[Improvement of graft fixation methods for reconstruction of the anterior cruciate ligament].  

PubMed

In N. N. Priorov Institute of Traumatology and Orthopedics, atografts with bone blocks have been extensively used over the last 10 years to reconstruct anterior cruciate ligament after sports, ballet, and circus injuries. The autografts are fixed by interference screws at the level of the articular space. Reconstruction of the anterior cruciate ligament by this technique was performed in more than 800 patients (99%) between 1998 and 2006. Positive outcome was achieved in the majority of the cases (93%). A more universal method for the fixation of autografts with bone blocks has been employed since 2005 using polylactic acid pins, the Rigidfix system, and Milago interference screws. The Rigidfix system is most suitable for revisional reconstruction and may serve as an alternative tool for the primary reconstruction of the anterior cruciate ligament. PMID:19065738

Orletski?, A K; Timchenko, D O

2008-01-01

129

Radiographic evaluation of native anterior cruciate ligament attachments and graft placement for reconstruction. A cadaveric study.  

PubMed

We examined seven cadaveric knees to determine the radiographic location of the native anterior cruciate ligament insertion sites as well as the location of tunnels used in anterior cruciate ligament reconstruction. Posteroanterior and lateral views at several flexion angles were taken with radiopaque markers around the insertions of the native anterior cruciate ligament and subsequent reconstruction tunnels. The femoral insertion was best seen on the 60 degrees notch view. On the lateral view, the femoral tunnel was easily seen as it crossed the roof of the intercondylar notch; however, because of the angle of the tunnel, the actual entrance into the knee may be well distal and anterior to this location. The tibial insertion and tunnel were easily seen at any flexion angle. The center of the insertion was 40% of the tibial diameter from the anterior margin. The lateral view in extension allowed determination of the tibial tunnel's location in relation to the intercondylar notch roof, but by itself did not allow accurate determination of the femoral tunnel's position. Notch and extension lateral radiographs together provided sufficient information for evaluation of anterior cruciate ligament graft position in a convenient, cost-effective format. Neither view by itself provides enough information to evaluate the position of the graft. PMID:8638757

Lintner, D M; Dewitt, S E; Moseley, J B

1996-01-01

130

Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction  

NASA Astrophysics Data System (ADS)

This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

2008-09-01

131

Effect of Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions on Pivot-Shift Kinematics in Anterior Cruciate Ligament and Meniscus-Deficient Knees  

Microsoft Academic Search

Background: Recent laboratory and clinical studies report no difference between single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.Hypothesis: Anatomical DB ACL reconstruction would restore knee kinematics in a complex injury model of ACL—meniscus injury closer to the intact state when compared with 2 common SB ACL reconstructions.Study Design: Controlled laboratory study.Methods: Five fresh-frozen cadaveric hip-to-toe lower extremity specimens

Volker Musahl; Asheesh Bedi; Musa Citak; Padhraig OLoughlin; Daniel Choi; Andrew D. Pearle

2011-01-01

132

Societal and Economic Impact of Anterior Cruciate Ligament Tears  

PubMed Central

Background: An anterior cruciate ligament (ACL) tear is a common knee injury, particularly among young and active individuals. Little is known, however, about the societal impacts of ACL tears, which could be large given the typical patient age and increased lifetime risk of knee osteoarthritis. This study evaluates the cost-effectiveness of ACL reconstruction compared with structured rehabilitation only. Methods: A cost-utility analysis of ACL reconstruction compared with structured rehabilitation only was conducted with use of a Markov decision model over two time horizons: the short to intermediate term (six years), on the basis of Level-I evidence derived from the KANON Study and the Multicenter Orthopaedic Outcomes Network (MOON) database; and the lifetime, on the basis of a comprehensive literature review. Utilities were assessed with use of the SF-6D. Costs (in 2012 U.S. dollars) were estimated from the societal perspective and included the effects of the ACL tear on work status, earnings, and disability. Effectiveness was expressed as quality-adjusted life years (QALYs) gained. Results: In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a QALY gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation. Conclusions: ACL reconstruction is the preferred cost-effective treatment strategy for ACL tears and yields reduced societal costs relative to rehabilitation once indirect cost factors, such as work status and earnings, are considered. The cost of an ACL tear over the lifetime of a patient is substantial, and resources should be directed to developing innovations for injury prevention and for altering the natural history of an ACL injury. PMID:24088967

Mather, Richard C.; Koenig, Lane; Kocher, Mininder S.; Dall, Timothy M.; Gallo, Paul; Scott, Daniel J.; Bach, Bernard R.; Spindler, Kurt P.

2013-01-01

133

Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction  

PubMed Central

Objective: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. Material and methods: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. Results: Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P < 0.05). Mean operation time was 235.27 ± 58.88 min in the improved tibial inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P < 0.05). Posterior drawer test were negative in 15 cases, slight positive in 2 with improved tibial inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. Conclusion: Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good.

Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

2014-01-01

134

Meniscus repair in the anterior cruciate deficient knee  

Microsoft Academic Search

From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 pa tients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent re pair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose

Gregory A. Hanks; Trenton M. Gause; John A. Handal; Alexander Kalenak

1990-01-01

135

A technique for arthroscopic fasciotomy for the chronic exertional tibialis anterior compartment syndrome.  

PubMed

Chronic exertional anterior compartment syndrome (CECS) is a condition that causes pain over the front of the shin bone that usually occurs in physically active people, especially runners. It may require sometimes an immediate fasciotomy. A longitudinal incision just over the fibula has used as surgical treatment bad cosmetic appearance. Although nowadays mini surgical incisions are preferred. The aim of this study to evaluate a simple fasciotomy technique with a minimal incision by using arthroscope. Nine legs of six patients that diagnosed as CECS has underwent fasciotomy operation with a 1 cm incision. Complaints had disappeared after operation. The mean follow-up time is 2 years. The results were good all of the patients and they never experienced exertional pain episodes. The arthroscopic assisted mini incisional fasciotomy technique has advantage such as early rehabilitation and good cosmetic appearance. PMID:18043906

Sebik, Ahmet; Do?an, Ali

2008-05-01

136

Initial fixation strength of polylactic acid interference screws in anterior cruciate ligament reconstruction  

Microsoft Academic Search

The initial fixation properties of bioresorbable polylactic acid (PLA) interference screws designed for anterior cruciate ligament reconstruction were evaluated using an in vitro bovine model. The surgical technique of interference screw fixation of the bone-patellar tendon-bone autograft complex performed clinically was reproduced in an adult bovine model. The reconstructed knee was tested oriented in 30 degrees of flexion to allow

JA Abate; PD Fadale; MJ Hulstyn; WR Walsh

1998-01-01

137

An Evaluation Method of EndoButton Position in MDCT Image After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Anterior Cruciate Ligament (ACL) reconstruction is performed to recover the injured knee which often happens in sports activity such as skiing, and basketball. The ACL reconstruction makes two bone tunnels in the femur and tibia. Then, the harvested graft passes the bone tunnels so that the femur and tibia are connected. The graft is fixed to the femur by using

Kouki Nagamune; Daisuke Arake; Koji Nishimot; Yuichi Hoshino; Seiji Kubo; Ryosuke Kuroda; Mashiro Kurosaka

2009-01-01

138

The Effect of Cryotherapy on Intraarticular Temperature and Postoperative Care After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

The objective of this study was to elucidate how cryotherapy after anterior cruciate ligament reconstruction affects intraarticular temperature and clinical results. A prospective and randomized study was performed on 21 knees of 21 patients. The ligament reconstruction was performed by single-incision arthroscopy using autogenous ham-string tendon. On completion of the surgery, thermosensors were implanted in the suprapatellar pouch and the

Yasumitsu Ohkoshi; Megumi Ohkoshi; Shinya Nagasaki; Aki Ono; Tomoyuki Hashimoto; Shigeru Yamane

1999-01-01

139

Comparison of Clinical and Dynamic Knee Function in Patients with Anterior Cruciate Ligament Deficiency  

Microsoft Academic Search

Background: Whether passive measures of isokinetic muscle strength deficits and knee laxity are related to the dynamic function of the anterior cruciate ligament-deficient knee remains unclear.Hypotheses: Arthrometer measurements are not predictive of peak external knee flexion moment (net quadriceps muscle moment), isokinetic quadriceps muscle strength correlates with peak external knee flexion moment (net quadriceps muscle moment), and isokinetic hamstring muscle

Rohita R. Patel; Debra E. Hurwitz; Charles A. Bush-Joseph; Bernard R. Bach; Thomas P. Andriacchi

2003-01-01

140

Effects of Knee Bracing on the Sensorimotor Function of Subjects with Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

The sensorimotor performance of the knee joint in 31 subjects who had undergone unilateral anterior cruciate ligament reconstruction at least 5 months previously was tested under three bracing conditions, 1) the DonJoy Legend brace, 2) a mechanical placebo brace, and 3) no brace, in random order. The accuracy of the subjects' ability to reproduce specified knee joint angles was tested

Gloria K. H. Wu; Gabriel Y. F. Ng; Arthur F. T. Mak

2001-01-01

141

The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Functional stability of the knee is dependent on an intact ligamentous system and the timely and efficient contraction of supporting musculature. The aim of this study was to assess the relationship between muscle strength and functional stability in 31 patients pre- and post-operatively, following a unilateral anterior cruciate ligament rupture. All subjects underwent reconstructive surgery using semitendonosis and gracilis tendons.

S. L. Keays; J. E. Bullock-Saxton; P. Newcombe; A. C. Keays

2003-01-01

142

The Effect of Physiotherapy on Standing Balance in Chronic Anterior Cruciate Ligament Insufficiency  

Microsoft Academic Search

Body sway movements in the frontal plane in a single- limbed stance test were used to assess postural control in 26 patients with chronic anterior cruciate ligament insufficiency. The injured and the noninjured legs were tested before the patients were committed to physio therapy for 3 to 6 months. Follow-up tests were made after 3, 12, and 36 months. Significant

Rose Zätterström; Thomas Friden; Anders Lindstrand; Ulrich Moritz

1994-01-01

143

Psychological Factors, Rehabilitation Adherence, and Rehabilitation Outcome After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Objective: To examine prospectively the relationships among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after knee surgery. Study Design and Participants: Individuals with acute anterior cruciate ligament (ACL) tears (N = 95) completed measures of self-motivation, social support, athletic identity, and psychological distress before reconstructive surgery. After surgery, participants (n = 93) reported on their completion of home rehabilitation

Britton W. Brewer; Judy L. Van Raalte; Allen E. Cornelius; Albert J. Petitpas; Joseph H. Sklar; Mark H. Pohlman; Robert J. Krushell; Terry D. Ditmar

2000-01-01

144

Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction  

Microsoft Academic Search

The purpose of this prospective study was to define constant anatomic intraarticular and extraarticular landmarks that can be used as definative reference points to reproducibly create a tibial tunnel for anterior cruciate ligament (ACL) reconstruction that (1) results in an impingement-free graft in full extension without an intercondylar roofplasty; (2) positions the tibial tunnel's intraarticular orafice sagittally central in the

Craig D. Morgan; Victor R. Kalman; Daniel M. Grawl

1995-01-01

145

Validation of the Thessaly test for detecting meniscal tears in anterior cruciate deficient knees  

Microsoft Academic Search

Meniscal injuries are frequently associated with anterior cruciate ligament (ACL) tears. Clinical tests that are useful for detecting meniscal tears may not be valid in this setting. The Thessaly test, a newly described dynamic clinical examination, has been shown to have a very high diagnostic accuracy for detecting meniscal tears. This study evaluates the accuracy of the Thessaly test in

Fardin Mirzatolooei; Zahra Yekta; Mojgan Bayazidchi; Solmaz Ershadi; Ahmadreza Afshar

2010-01-01

146

Outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose: To determine the healing rate of meniscal repair using the Meniscus Arrow (Bionx, Blue Bell, PA) in patients undergoing concurrent anterior cruciate ligament (ACL) reconstruction and to evaluate patient outcomes with the International Knee Documentation Committee (IKDC) form and a visual analog scale (VAS). Type of Study: Case series with outcomes analysis. Methods: We retrospectively analyzed 38 consecutive patients

Sanjitpal S. Gill; David R. Diduch

2002-01-01

147

The sequelae of salvaged nondegenerative peripheral vertical medial meniscus tears with anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose: To determine the clinical sequelae of nondegenerative peripheral vertical medial meniscus tears treated with abrasion and trephination alone (stable tears) or suture repair (unstable tears). Type of Study: Cohort follow-up. Methods: At the time of anterior cruciate ligament reconstruction, 548 patients had nondegenerative peripheral vertical medial meniscus tears that were either left unsutured or repaired. Of 548 menisci, 233

K. Donald Shelbourne; Bart P. Rask

2001-01-01

148

Observation of anomalous insertion of the medial meniscus on the anterior cruciate ligament  

Microsoft Academic Search

We wanted to determine the frequency of occurrence and types of anomalous insertions of the medial meniscus to the anterior cruciate ligament (ACL) in Finnish patients. In 987 consecutive arthroscopies from January 1996 to August 1998, the meniscal pathology was mapped using videoprints and drawings. We found 11 anomalous medial meniscus insertions to the ACL. There were 4 female and

Petri Rainio; Janne Sarimo; Jussi Rantanen; Jouko Alanen; Sakari Orava

2002-01-01

149

Level of Evidence in Anterior Cruciate Ligament Reconstruction Research: A Systematic Review  

Microsoft Academic Search

BACKGROUND:There have been numerous studies on anterior cruciate ligament (ACL) reconstruction. Considering the vast number of studies, a quick assessment reveals rather few with a high level of evidence. PURPOSE:The primary aim was to categorize the study type and level of evidence of studies on primary ACL reconstruction by applying the level of evidence rating system proposed by the Oxford

K. Samuelsson; N. Desai; E. McNair; C. F. van Eck; M. Petzold; F. H. Fu; M. Bhandari; J. Karlsson

2012-01-01

150

Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee  

Microsoft Academic Search

BACKGROUND: Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this study was to determine further if ACL deficient knees show abnormal JPS and the effect of exercise therapy on JPS, and also to assess the relation between JPS, functional stability,

N D Carter; T R Jenkinson; D Wilson; D W Jones; A S Torode

1997-01-01

151

Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.  

ERIC Educational Resources Information Center

Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

2001-01-01

152

Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study  

PubMed Central

[Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury. PMID:25364100

Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

2014-01-01

153

The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament.  

PubMed

When faced with a clinical suspicion of knee ligament injury, MRI nowadays has a central role in the diagnostic strategy. In particular, it is essential for assessing the cruciate ligaments and any associated meniscal tears. The objective of this review is to present the various direct and indirect MRI signs of tearing of the anterior cruciate ligament (ACL) and then describe the lesions associated with it. The anatomical and clinical aspects are also discussed so that the contribution of MRI to the diagnosis and therapeutic management of an ACL tear can be better understood. PMID:22542209

Guenoun, D; Le Corroller, T; Amous, Z; Pauly, V; Sbihi, A; Champsaur, P

2012-05-01

154

Football Cleat Design and Its Effect on Anterior Cruciate Ligament InjuriesA Three-Year Prospective Study  

Microsoft Academic Search

A 3-year prospective study was initiated to evaluate torsional resistance of modern football cleat designs and the incidence of surgically documented anterior cruciate ligament tears in high school football players wearing different cleat types. We compared four styles of football shoes and evaluated the incidence of ante rior cruciate ligament tears among 3119 high school football players during the 1989

Rick B. Lambson; Bill S. Barnhill; Robert W. Higgins

1996-01-01

155

Potential commercial application of a bi-layer bone-ligament regeneration scaffold to anterior cruciate ligament replacement  

E-print Network

A business model was created in order to explore the commercial application of a bi-layer bone-ligament scaffold to the treatment of torn anterior cruciate ligaments (ACL) requiring replacement. The two main keys in producing ...

Li, Jessica C. (Jessica Ching-Yi)

2006-01-01

156

The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes  

Microsoft Academic Search

Background: Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men.Purpose: To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury.Study Design: Case control study; Level of evidence,

Gregory D. Myer; Kevin R. Ford; Mark V. Paterno; Todd G. Nick; Timothy E. Hewett

2008-01-01

157

Surgical technique, using skin, for repair of simultaneously ruptured anterior cruciate and medial collateral ligaments of the canine femorotibial articulation  

E-print Network

for the repair of sinultaneously ruptured anterior cruciate and nedial collateral liganents of the canine stifle (fssoro- tibial) joint. Much attention has bean given to the lesions of the stifle joint in the large dcssestic anhaals, However, the lesions... involve the Iiganents, with osteo- arthritis developing later as a result of abnornal notion within the joint. 13 15 7 Nilsson, Paatsana, and Gibbens describe nethods for repairing ruptures of the nedial collateral and anterior cruciate liganents...

Chastain, Jamie Neal

2012-06-07

158

The Relationship Between Quadriceps Muscle Force, Knee Flexion, and Anterior Cruciate Ligament Strain in an In Vitro Simulated Jump Landing  

Microsoft Academic Search

Background: An instrumented cadaveric knee construct was used to quantify the association between impact force, quadriceps force, knee flexion angle, and anterior cruciate ligament relative strain in simulated unipedal jump landings.Hypothesis: Anterior cruciate ligament strain will correlate with impact force, quadriceps force, and knee flexion angle.Study Design: Descriptive laboratory study.Methods: Eleven cadaveric knees (age, 70.8 [19.3] years; 5 male; 6

Thomas J. Withrow; Laura J. Huston; Edward M. Wojtys; James A. Ashton-Miller

2006-01-01

159

Psychological Rehabilitation From Anterior Cruciate Ligament-Medial Collateral Ligament Reconstructive Surgery  

PubMed Central

Background: Research has shown that some of the more common psychological responses to injury (ie, depression, anger, anxiety) are amplified in cases of traumatic injury. Hypothesis/Purpose: An 18-year-old male scholarship soccer player who, owing to a perceived deliberate injurious tackle by an opposition player, tore the medial collateral ligament and anterior cruciate ligament of his right knee. A psychological case perspective is presented. Study Design: Retrospective case report. Results: Various personal and situational factors can compound negative psychological response to injury. A number of extreme responses are explored, including posttraumatic stress, depression, and fear of reinjury. Conclusions: Practitioners should be willing and able to facilitate referral in the instance of more extreme psychological response to anterior cruciate ligament injury. PMID:23015925

2010-01-01

160

Prevalence of Septic Arthritis After Anterior Cruciate Ligament Reconstruction Among Professional Athletes  

Microsoft Academic Search

Background: Septic arthritis of the knee after anterior cruciate ligament (ACL) reconstruction is a rare complication. Its prevalence and characteristics have never been reported among professional athletes.Purpose: To report the prevalence and the characteristics of septic arthritis after ACL reconstruction in professional athletes and a general population of patients.Study Design: Case control study; Level of evidence, 3.Methods: A retrospective analysis

Bertrand Sonnery-Cottet; Pooler Archbold; Rachad Zayni; Juliano Bortolletto; Mathieu Thaunat; Thierry Prost; Vitor B. C. Padua; Pierre Chambat

2011-01-01

161

Postoperative Analgesia with Controlled-Release Oxycodone for Outpatient Anterior Cruciate Ligament Surgery  

Microsoft Academic Search

Reconstruction of the anterior cruciate ligament (ACL) of the knee is associated with a considerable degree of post- operative pain. Although immediate-release oral opioids are usually effective in relieving moderate to severe pain, they must be given every 4-6 h. A controlled-release (CR) formulation of oxycodone maintains therapeutic opioid concentrations for a more prolonged period, thus provid- ing sustained pain

Scott S. Reuben; Neil Roy Connelly; Holly Maciolek

1999-01-01

162

Comparative study of autograft or allograft in primary anterior cruciate ligament reconstruction  

Microsoft Academic Search

Between December 1996 and December 2002, we treated 79 patients with arthroscopy-assisted anterior cruciate ligament (ACL) reconstructions. In 53 patients we used autografts and in 26 patients allografts. Patients were followed up for 38 (12–72) months. The two groups did not differ in preoperative sport activity level. The postoperative Lysholm score was 89.9±8.1 in the autograft group and 84.1±18.6 in

T. Kustos; L. Bálint; P. Than; Tamás Bárdos

2004-01-01

163

Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers  

Microsoft Academic Search

Rotational stability of the knee has been traditionally difficult to quantify, limiting the ability of the orthopedic community\\u000a to determine the potential role of rotational laxity in the etiology of anterior cruciate ligament (ACL) injuries. The purposes\\u000a of this multicenter cohort study were to evaluate the reliability of a robotic axial rotation measurement system, determine\\u000a whether the uninjured knees of

T. P. Branch; J. E. Browne; J. D. Campbell; R. Siebold; H. I. Freedberg; E. A. Arendt; F. Lavoie; P. Neyret; Cale A. Jacobs

2010-01-01

164

Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction  

Microsoft Academic Search

The hamstrings musculature is a vital component of an intricate dynamic knee joint restraint mechanism. However, there is\\u000a evidence based on research studies suggesting potential deficits to this complex mechanism due to donor site morbidity resulting\\u000a from harvest of the ipsilateral semitendinosus and gracilis autograft (ISGA) for anterior cruciate ligament reconstruction\\u000a (ACLR). The purpose of this retrospective research study was

Giampietro L. Vairo; Joseph B. Myers; Timothy C. Sell; Freddie H. Fu; Christopher D. Harner; Scott M. Lephart

2008-01-01

165

Anterior cruciate ligament injury in elite football: a prospective three-cohort study  

Microsoft Academic Search

Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury\\u000a and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related\\u000a differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort\\u000a study was to describe

Markus Waldén; Martin Hägglund; Henrik Magnusson; Jan Ekstrand

2011-01-01

166

Clinical evidence of a familial predisposition to anterior cruciate ligament injury  

Microsoft Academic Search

BackgroundSeveral risk factors for anterior cruciate ligament (ACL) injury have been evaluated in the literatures. It is highly probable that many of the identified risk factors for ACL injury are passed through families. However few articles describe a familial predisposition to ACL injury.ObjectiveTo investigate whether there is a familial predisposition to ACL injury.DesignRetrospective study.MethodsThe study group comprised 350 consecutive patients

K Goshima; K Kitaoka; J Nakase; R Takahashi; H Tsuchiya

2011-01-01

167

Delayed gastrocnemius muscle response to sudden perturbation in rehabilitated patients with anterior cruciate ligament reconstruction  

Microsoft Academic Search

This nonrandomized, posttest-only comparison between two experimental groups and a control group compared the lower extremity muscle activation latencies of patients following rehabilitated unilateral anterior cruciate ligament (ACL) reconstruction (allograft or autograft bone-patellar tendon-bone tissue) and normal control subjects. Twenty-three subjects (seven allograft, eight autograft, eight normal control) of similar age, height, weight, isokinetic knee extensor, and flexor peak torque\\/bodyweight,

Donna J. Oeffinger; Robert Shapiro; John Nyland; David Pienkowski; David N. M. Caborn

2001-01-01

168

Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon  

PubMed Central

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures. PMID:24639949

Lee, Gwang Chul; Park, Sung-Hae

2014-01-01

169

Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts  

Microsoft Academic Search

We report a prospective series evaluating the incidence and degree of tunnel widening in a well-matched series of patients\\u000a receiving a hamstring or patella tendon graft for anterior cruciate ligament (ACL) deficiency. We correlated tunnel widening\\u000a with clinical factors, knee scores, KT-1000 and isokinetic muscle strength to determine the clinical significance of this\\u000a finding. Seventy-three patients at least 12 months

M. G. Clatworthy; P. Annear; J.-U. Bulow; R. J. Bartlett

1999-01-01

170

A Randomized Controlled Trial to Prevent Noncontact Anterior Cruciate Ligament Injury in Female Collegiate Soccer Players  

Microsoft Academic Search

Background: Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large.Hypothesis: A simple on-field alternative warm-up program can reduce noncontact ACL injuries.Study Design: Randomized controlled trial (clustered); Level of evidence, 1.Methods: Participating National Collegiate Athletic Association Division I women's soccer teams were

Julie Gilchrist; Bert R. Mandelbaum; Heidi Melancon; George W. Ryan; Holly J. Silvers; Letha Y. Griffin; Diane S. Watanabe; Randall W. Dick; Jiri Dvorak

2008-01-01

171

Recovery of extensor muscle strength in athletes after anterior cruciate ligament reconstruction  

Microsoft Academic Search

We investigated the effects of the use of different autograft materials on the early postoperative recovery of extensor muscle\\u000a strength after anterior cruciate ligament (ACL) reconstruction. Reconstruction was performed in 172 athletes with ACL-deficient\\u000a knees; in 32, a quadriceps tendon-patellar tendon substitute (QTS) was used; in 79, semitendinosus and gracilis tendons (STG)\\u000a were used; and in 61, a bone-patellar tendon-bone

Sadao Niga; Haruyasu Yamamoto; Kohtaro Furuya

1996-01-01

172

Allograft anterior cruciate ligament reconstruction in patients over 40 years of age  

Microsoft Academic Search

Purpose: The study goal was to determine the results of allograft anterior cruciate ligament (ACL) reconstruction in patients over 40 years old at a minimum of 24 months follow-up (mean, 59.7 months; range, 24 to 110 months). Type of Study: Retrospective review. Methods: The records of 57 consecutive patients (mean age at surgery, 45.0 years; range, 40.2 to 60.8 years)

David K. Kuechle; Sara E. Pearson; William R. Beach; Eric L. Freeman; David F. Pawlowski; Terry L. Whipple; John F. Meyers

2002-01-01

173

Force Measurements in the Medial Meniscus Posterior Horn Attachment: Effects of Anterior Cruciate Ligament Removal  

Microsoft Academic Search

Background: Tears of the medial meniscus posterior horn attachment (PHA) occur clinically, and an anterior cruciate ligament (ACL)–deficient knee may be more vulnerable to this injury.Hypothesis: The PHA forces from applied knee loadings will increase after removal of the ACL.Study Design: Controlled laboratory study.Methods: A cap of bone containing the medial meniscus PHA was attached to a load cell that

Keith L. Markolf; Steven R. Jackson; David R. McAllister

2012-01-01

174

The effects of hyaluronan on the meniscus in the anterior cruciate ligament-deficient knee  

Microsoft Academic Search

:   Anterior cruciate ligament (ACL) deficiency often induces meniscal tears and, ultimately, degenerative joint disease. The\\u000a hypothesis of this study was that hyaluronan (HA; MW = 8 × 105) may have a protective effect on the medial meniscus following a period of ACL deficiency. The animal model consisted of\\u000a creating an ACL deficiency by ACL transection (ACLT) in 51 mature

Masaki Sonoda; Frederick L. Harwood; Michael E. Amiel; Hideshige Moriya; David Amiel

2000-01-01

175

A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery  

Microsoft Academic Search

Objective:To determine whether the psychological characteristics of athletes who have undergone an anterior cruciate ligament (ACL) reconstruction change during rehabilitation are related to returning to competitive sport.Design:Prospective longitudinal study.Method:87 athletes completed the Emotional Response of Athletes to Injury Questionnaire (ERAIQ) and the ACL Return to Sport after Injury scale (ACL-RSI) at 3, 6 and 12 months following ACL reconstruction surgery.

J L Langford; K E Webster; J A Feller

2009-01-01

176

KINEMATICS AND MYOELECTRIC ANALYSIS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTED KNEE IN DROP LANDING - A PILOT STUDY  

Microsoft Academic Search

This study aimed to investigate the 'lower extremity kinematics and electromyography (EMG) of anterior cruciate ligament (ACL) reconstructed knee during single-leg drop landing. One female elite basketball athlete rehabilitated from ACL reconstruction surgery 33 months prior this study performed five trials of single-leg drop landing from a 300mm­ high platform with the arms crossed over the chest. The motion in

Alice Ka-Ki Man; Daniel Tik-Pui Fong; Youlian Hong

177

The common mechanisms of anterior cruciate ligament injuries in judo: a retrospective analysis  

Microsoft Academic Search

BackgroundAlthough high prevalence of anterior cruciate ligament injuries (ACL) in judokas has been reported, there has been very little research concerning events preceding the injury.ObjectiveTo determine the common situations and mechanisms of ACL injury in judo.MethodsA total of 43 cases of ACL injuries that had occurred during judo competition or practice were investigated, using questionnaires with interviews conducted by a

S. Koshida; T. Deguchi; K. Miyashita; K. Iwai; Y. Urabe

2010-01-01

178

Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction  

Microsoft Academic Search

The anterior cruciate ligament (ACL) is the most commonly-injured knee ligament during sporting activities. After injury, most individuals experience episodes of the knee giving way during daily activities (non-copers). Non-copers demonstrate asymmetrical quadriceps strength and movement patterns, which could have long-term deleterious effects on the integrity of the knee joint. The purpose of this study was to determine if non-copers

Ben D. Roewer; Stephanie L. Di Stasi; Lynn Snyder-Mackler

2011-01-01

179

Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines  

Microsoft Academic Search

Purpose  Anterior cruciate ligament (ACL) mucoid degeneration is a rare encounter in clinical practice, different, but often confused\\u000a with ACL mucoid cysts. Its pathophysiology remains unclear. However, recent publications have suggested that it might be underdiagnosed\\u000a or misdiagnosed, and that the adverse effects of treatment by ACL resection might be underestimated. The object of this work\\u000a was to summarize this scattered

Francois Lintz; Nicolas Pujol; Philippe Boisrenoult; Kevin Bargoin; Philippe Beaufils; David Dejour

2011-01-01

180

Tuberculum intercondylare tibiae tertium as a predictive factor for anterior cruciate ligament injury.  

PubMed

The aim of this study was to assess the presence of tuberculum intercondylare tibiae tertium, also known as Parsons' knob, and to determine its prominence. Knee radiographs of 171 patients operated on for anterior cruciate ligament injury were examined. The control group included 120 sex- and age-matched patients who underwent orthopaedic examination for knee pain, in whom anterior cruciate ligament injury was ruled out. Knee radiographs revealed the presence of tuberculum intercondylare tibiae tertium in 55 (32.2%) and 16 (13.3%) patients from the study and control groups, respectively. The between-group difference was statistically significant. The authors developed their own method of tuberculum intercondylare tibiae tertium measurement using proportional coefficients based on the length of the tibial plateau to compare the values of the tuberculum intercondylare tibiae tertium. The results showed tuberculum intercondylare tibiae tertium to be not only more common but also more pronounced, especially in height, in the patients with anterior cruciate ligament lesions. PMID:11734481

Pe?ina, M; Bajok, I; Pe?ina, H I

2001-01-01

181

Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation Progression  

PubMed Central

SYNOPSIS The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology. PMID:22402434

ADAMS, DOUGLAS; LOGERSTEDT, DAVID; HUNTER-GIORDANO, AIRELLE; AXE, MICHAEL J.; SNYDER-MACKLER, LYNN

2013-01-01

182

Arthroscopic anterior and posterior labral repair after traumatic hip dislocation: case report and review of the literature.  

PubMed

With the improvements in flexible instrumentation, hip arthroscopy is being increasingly used to treat a variety of hip pathology, including labral tears. However, up to this point, there has not been a case report of an anterior and a posterior labral tear successfully repaired arthroscopically. We present a case report of a 27-year-old male firefighter who presented to our institution with an anterior and posterior labral tear, as well as a cam lesion and loose body, following a traumatic hip dislocation. The purpose of this case report is to illustrate that both anterior and posterior labral tears can be repaired using hip arthroscopy. Anterior and posterior labral tears can be caused by a traumatic hip dislocation, and both can be successfully repaired using arthroscopic techniques. PMID:21886540

Cross, Michael B; Shindle, Michael K; Kelly, Bryan T

2010-09-01

183

A novel technique of graft passage in arthroscopically assisted posterior cruciate ligament reconstruction.  

PubMed

Graft passage for cruciate reconstruction can be troublesome. Specific to the posterior cruciate ligament, difficulties can arise after tunnel preparation when trying to retrieve the graft at the back of the knee, because of the angles involved. We recommend directing a cable passer through the notch toward the tibial tunnel. Once engaged, a cerclage wire can be passed antegrade into the tunnel. Pituitary forceps can be passed to deliver the wire. The wire is looped around the pull-through suture attached to the graft and is pulled into the notch. This can then be retrieved during femoral tunnel preparation before locking. This technique can be made easier via a mini-medial arthrotomy or careful digital palpation via any posterior incisions used in the acute setting to address other injuries. To remain inside the joint capsule, we advocate the use of image intensification. The extent of soft-tissue dissection and amount of surgical time can be reduced by use of this method, and it should be added to the armamentarium of surgical procedures in existence for graft passage in posterior cruciate ligament reconstruction. PMID:17681218

Miller, David; Roach, Richard

2007-08-01

184

An In Vitro Biomechanical Comparison of Anterior Cruciate Ligament Reconstruction: Single Bundle Versus Anatomical Double Bundle Techniques  

PubMed Central

INTRODUCTION Anterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction). OBJECTIVES To compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study. METHODS Nine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle) and group B (anatomical reconstruction). Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion. RESULTS There were no differences between the two techniques for any of the measurements by ANOVA tests. CONCLUSION The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation. PMID:18297210

Sasaki, Sandra Umeda; Albuquerque, Roberto Freire da Mota e; Pereira, Cesar Augusto Martins; Gouveia, Guilherme Simoes; Vilela, Julio Cesar Rodrigues; de Lima Alcaras, Fabio

2008-01-01

185

The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes  

PubMed Central

Background Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men. Purpose To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury. Study Design Case control study; Level of evidence, 3. Methods From 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injury status from recorded laxity measures. Results A multivariable logistic regression model (chi-square = 18.6; P = .002) used the independent variables laxity measures of knee hyperextension (P = .02), wrist and thumb to forearm opposition (P = .80), fifth-finger hyperextension >90° (P = .71), side-to-side differences in anterior-posterior tibiofemoral translation (P = .002), and prior knee injury (P = .22) to predict anterior cruciate ligament–injury status. The validated C statistic, or validated area under the receiver operating characteristic curve, was 0.72. For every 1.3-mm increase in side-to-side differences in anterior-posterior knee displacement, the odds of anterior cruciate ligament–injured status increased 4-fold (95% confidence interval, 1.68–9.69). A positive measure of knee hyperextension increased the odds of anterior cruciate ligament–injured status 5-fold (95% confidence interval, 1.24–18.44). Conclusion The current results indicate that increased knee-laxity measures may contribute to increased risk of anterior cruciate ligament injury. The methods to quantify knee joint laxity in this report may be used in conjunction with measures of neuromuscular control of the knee joint to identify high-risk female athletes with high accuracy. Once high-risk female athletes are identified, they may be targeted to the appropriate interventions to reduce injury risk. PMID:18326833

Myer, Gregory D.; Ford, Kevin R.; Paterno, Mark V.; Nick, Todd G.; Hewett, Timothy E.

2012-01-01

186

Rehabilitation and return to play after anatomic anterior cruciate ligament reconstruction.  

PubMed

Rehabilitation after anterior cruciate ligament (ACL) reconstruction should consider control of postoperative pain and swelling, protection of the healing graft, restoration of full range of motion symmetric to the contralateral knee, strengthening of the muscles that stabilize the knee, hip, and trunk, enhancing neuromuscular control, and a gradual progression to functional activities that are required for return to sports. The effects of concomitant injuries and surgical procedures must also be considered in planning an individualized rehabilitation program. This article provides an overview, discusses our experience, and makes recommendations for rehabilitation after anatomic ACL reconstruction rehabilitation. PMID:23177470

Yabroudi, Mohammad A; Irrgang, James J

2013-01-01

187

Nonoperative treatment of partial-thickness meniscal tears identified during anterior cruciate ligament reconstruction.  

PubMed

The reported incidence and treatment of partial-thickness meniscal tears seen at anterior cruciate ligament (ACL) reconstruction varies widely. The success of nonoperative treatment of partial meniscal tears identified during ACL reconstruction at our institution was reviewed. All incomplete meniscal tears were treated with observation, all full-thickness tears were treated with repair or partial meniscectomy. Partial tears of the lateral meniscus were noted three times more commonly than in the medial meniscus and were seen more acutely after ACL injury than full-thickness tears. At 2-year follow-up, excellent knee function was noted when these tears were treated nonoperatively. PMID:15315046

Zemanovic, Jason R; McAllister, David R; Hame, Sharon L

2004-07-01

188

"Retrograde Technique" for Drilling the Femoral Tunnel in an Anterior Cruciate Ligament Reconstruction  

PubMed Central

Recent literature has led some surgeons to drill the femoral tunnel in an anterior cruciate ligament reconstruction through an accessory anteromedial portal. Several techniques have been reported for the safe, effective drilling of the femoral tunnel by this approach. This technical note presents a new “retrograde technique” in which all instruments are passed independently into the notch and across the medial compartment. This technique is safe and reproducible and allows for meticulous evaluation and creation of the femoral tunnel(s) while minimizing steps. PMID:24400188

Branam, Barton R.; Hasselfeld, Kimberly A.

2013-01-01

189

Radial displacement of the lateral meniscus before and after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Introduction  The purpose of this study was to investigate radial displacement (RD) of the lateral meniscus in patients with anterior cruciate\\u000a ligament (ACL) injury by using magnetic resonance imaging both pre- and post-operatively.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  This study included 59 knees that had undergone ACL reconstruction. The length that extruded from the lateral tibial plateau\\u000a was measured in the coronal plane.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Mean

Atsushi Ichiba; Kaoru Makuya

190

Tiludronate treatment improves structural changes and symptoms of osteoarthritis in the canine anterior cruciate ligament model  

Microsoft Academic Search

Introduction  The aim of this prospective, randomized, controlled, double-blind study was to evaluate the effects of tiludronate (TLN),\\u000a a bisphosphonate, on structural, biochemical and molecular changes and function in an experimental dog model of osteoarthritis\\u000a (OA).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Baseline values were established the week preceding surgical transection of the right cranial\\/anterior cruciate ligament,\\u000a with eight dogs serving as OA placebo controls and eight

Maxim Moreau; Pascale Rialland; Jean-Pierre Pelletier; Johanne Martel-Pelletier; Daniel Lajeunesse; Christielle Boileau; Judith Caron; Diane Frank; Bertrand Lussier; Jerome RE del Castillo; Guy Beauchamp; Dominique Gauvin; Thierry Bertaim; Dominique Thibaud; Eric Troncy

2011-01-01

191

Modeling the growth plates in the pediatric knee: implications for anterior cruciate ligament reconstruction.  

PubMed

The authors develop 3-D models of the pediatric knee from magnetic resonance imaging (MRI) image files, with the goal of minimizing injury to the pediatric growth plate during surgery. Computerized tomography (CT) scans have better resolution and contrast between bone and soft tissue than MRI scans; however, surgeons rely upon MRI scans to plan knee-joint surgeries such as anterior cruciate ligament (ACL) reconstruction. Surgeons can use the virtual models to plan and verify surgical procedures such as hole drilling and ligament attachments, and to determine volume removed from a growth plate due to different drill-hole placements with various drill sizes. PMID:15464881

Guarino, J; Tennyson, S; Barrios, Y; Shea, K; Pfeiffer, R; Sabick, M

2004-10-01

192

Anterior cruciate ligament reconstruction. Bone-patella tendon-bone versus semitendinosus anatomic reconstruction.  

PubMed

In this article, the long term (2-10 years; mean, 4.8 years) followup results of two reconstructive procedures for the anterior cruciate ligament are compared. The bone-patella tendon-bone (with interference fit fixation) was performed on 69 knees, and the semitendinosus anatomic reconstruction was performed on 68 knees, in a population of 76 men and 52 women (age range, 15-60 years; average, 31 years). The patients in the two groups showed no difference in subjective results or activity level and no significant difference to manual testing. The semitendinosus procedure group had a slightly higher KT manual maximum failure rate than the patella tendon group (17% versus 11%). Arthrometric stability did not show deterioration, but patient satisfaction decreased in those patients who had meniscectomies. Both procedures showed satisfactory results during the long term followup. However, if the secondary restraints are compromised, the stiffer bone-patella tendon-bone construct is preferred for reconstruction of the chronic anterior cruciate ligament deficient knee. PMID:9269157

Feagin, J A; Wills, R P; Lambert, K L; Mott, H W; Cunningham, R R

1997-08-01

193

One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction  

PubMed Central

Introduction: Main evidence of the heavy knee dislocations is the rupture of both Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). There are limited sources for the treatment of both ligaments at a single stage. Materials-method: One-staged anatomic double-bundle ACL and PCL reconstruction technique has been applied to 2 cases aged 20 and 36 with traumatic knee dislocation. Lateral collateral ligament and posteriolateral corner reconstruction added to one case, and medial collateral ligament and posteriomedial corner reconstruction for the other case. Because of additional femur fractures of the both cases, ligament reconstructions have been applied after the main treatment. Anterior tibialis tendon (ATT) allograft has been used for graft for both cases because of other stabilization deficiencies of knees. It has been confirmed that femoral and tibial tunnels constructed with anatomic double-bundle technique are fitting to anatomic locations by the post-operation CT results. Post fixation screw has been used for tibia, and endobutton at femur. Results: Tracking records of patients at 8th month shows that; Lysholm score of the case aged 20 was 89, and 85 for the case aged 36. While KT-1000 values was 3.7 mm, and 4.1 mm for 15 N power; and 9.1 mm-9.6 mm with the maximum power. Conclusion: Surgical technical details of one-staged double-bundle reconstruction for ACL and PCL injuries which is gaining popularity recently has been stated.

Acar, Baver; Ba?ar?r, Kerem; Armangil, Mehmet; Binnet, Mehmet Serdar

2014-01-01

194

Quantitative evaluation of anterior tibial translation during isokinetic motion in knees with anterior cruciate ligament reconstruction using either patellar or hamstring tendon grafts  

Microsoft Academic Search

We studied 79 patients with unilateral injury to the anterior cruciate ligament (ACL). The patients were randomly allocated\\u000a to reconstruction with autologous patellar bone-tendon-bone (BTB) grafts (49 knees) or hamstring tendon (ST) grafts (30 knees).\\u000a We measured anterior tibial translation (ATT) during isokinetic concentric contraction exercise 18–20 months after surgery\\u000a using a computerized electrogoniometer. In both groups the highest ATT during

N. Sato; H. Higuchi; M. Terauchi; M. Kimura; K. Takagishi

2005-01-01

195

Incidence of Anterior Cruciate Ligament Injuries Among Elite Ballet and Modern DancersA 5-year Prospective Study  

Microsoft Academic Search

Background: Ballet and modern dance are jump-intensive activities, but little is known about the incidence of anterior cruciate ligament (ACL) injuries among dancers.Hypothesis: Rigorous jump and balance training has been shown in some prospective studies to significantly reduce ACL injury rates among athletes. Dancers advance to the professional level only after having achieved virtuosic jump and balance technique. Therefore, dancers

Marijeanne Liederbach; Faye E. Dilgen; Donald J. Rose

2008-01-01

196

Anterior Cruciate Ligament Graft FixationInitial Comparison of Patellar Tendon and Semitendinosus Autografts in Young Fresh Cadavers  

Microsoft Academic Search

The initial biomechanical properties of semitendinosus and patellar tendon autografts and their fixation strengths were investigated. Twenty fresh cadaveric knees from donors under 42 years of age were used in the study. After removing all soft tissues other than the anterior cruciate ligament, we determined the ultimate tensile strength (2195 ± 427 N) and stiffness (306 ± 80 N\\/mm) of

Neville J. Rowden; Doron Sher; Greg J. Rogers; Klaus Schindhelm

1997-01-01

197

Electromechanical Delay of the Knee Flexor Muscles Is Impaired After Harvesting Hamstring Tendons for Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Changes in electromechanical delay during muscle activation are expected when there are substantial alterations in the structural properties of the musculotendinous tissue. In anterior cruciate ligament reconstruction, specific tendons are being harvested for grafts. Thus, there is an associated scar tissue development at the tendon that may affect the corresponding electromechanical delay.Purpose: This study was conducted to investigate whether

Stavros Ristanis; Elias Tsepis; Dimitrios Giotis; Nicholas Stergiou; Guiliano Cerulli; Anastasios D. Georgoulis

2009-01-01

198

A stochastic biomechanical model for risk and risk factors of non-contact anterior cruciate ligament injuries  

Microsoft Academic Search

Gender has been identified as a risk factor for non-contact anterior cruciate ligament (ACL) injuries. Although some possible biomechanical risk factors underlying the gender differences in the risk for non-contact ACL injuries have been identified, they have not been quantitatively confirmed yet because of the descriptive nature of the traditional epidemiological methods. The purpose of this study was to validate

Cheng-Feng Lin; Michael Gross; Chuanshu Ji; Darin Padua; Paul Weinhold; William E. Garrett; Bing Yu

2009-01-01

199

Does a torn anterior cruciate ligament lead to change in the central nervous drive of the knee extensors?  

Microsoft Academic Search

Summary  Integrated surface electromyograms of the three superficial parts of the quadriceps and isokinetic knee extensor maximum torque and power production were recorded simultaneously and at different angular velocities in both legs in 11 male subjects with unilateral tear of the anterior cruciate ligament. The cross-sectional area (CSA) of the thigh and its muscular components were measured by computerized tomography. The

Lars-Gunnar Elmqvist; Ronny Lorentzon; Christer Johansson; Axel R. Fugl-Meyer

1988-01-01

200

Selecting outcome measures in sports medicine: a guide for practitioners using the example of anterior cruciate ligament rehabilitation  

Microsoft Academic Search

Using examples from the field of anterior cruciate ligament rehabilitation, this review provides sports and health practitioners with a comprehensive, user-friendly, guide to selecting outcome measures for use with active populations. A series of questions are presented for consideration when selecting a measure: is the measure appropriate for the intended use? (appropriateness); is the measure acceptable to patients? (acceptability); is

N P Bent; C C Wright; A B Rushton; M E Batt

2009-01-01

201

Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees  

Microsoft Academic Search

Through the retrospective study of 1103 reconstructions of the anterior cruciate ligament (ACL) performed between 1984 and 1993, we try to outline the natural history of meniscal tears in acute lesions and in chronic insufficiency of the ACL. According to a more accurate evaluation of the clinical evolution, ACL-deficient knees can be classified into four different stages: acute, subacute, subchronic

M. Cipolla; A. Scala; E. Gianni; G. Puddu

1995-01-01

202

Simultaneous bucket handle tear of both medial and lateral menisci of a knee with chronic anterior cruciate ligament deficiency  

Microsoft Academic Search

Bucket handle meniscus tears constitute about 10% of all meniscal tears. Bucket handle tears of medial meniscus is three times more than lateral meniscus. Most of these tears are associated with anterior cruciate ligament (ACL) deficiency. Lateral meniscus lesions are more common with acute ACL deficiency, where medial meniscus lesions are more associated with chronic ACL deficiency. We identified bucket

Ozgur Cetik; Meric Cirpar; Fatih Eksioglu; Murad Uslu

2006-01-01

203

The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose: The goal of this study was to determine the long-term subjective and objective results for patients with lateral meniscus tears found at the time of anterior cruciate ligament (ACL) reconstruction that were left in situ or abraded and trephined but not repaired or removed. Type of Study: Retrospective review of prospectively collected data. Methods: From a database of ACL

K. Donald Shelbourne; John Heinrich

2004-01-01

204

High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury  

Microsoft Academic Search

Objective. To determine the prevalence of radio- graphic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury. Methods. Female soccer players who sustained an ACL injury 12 years earlier were examined with stan- dardized weight-bearing knee radiography and 2 self- administered patient questionnaires, the Knee

L. S. Lohmander; M. Englund; H. Roos

2004-01-01

205

Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods  

Microsoft Academic Search

BackgroundDespite the ongoing evolution of anterior cruciate ligament injury prevention methods, injury rates and the associated sex-disparity remain. Strategies capable of successfully countering key control parameters existent within the injury mechanism thus remain elusive. Forward dynamics model simulations afford an expedited means to study realistic injury causing scenarios, while controlling all facets of the movement control strategy. Utilizing these methods,

Scott G. McLean; Xuemei Huang; Antonie J. van den Bogert

2008-01-01

206

Effect of cross exercise on quadriceps acceleration reaction time and subjective scores (Lysholm questionnaire) following anterior cruciate ligament reconstruction  

Microsoft Academic Search

BACKGROUND: Anterior cruciate ligament (ACL) injury or reconstruction can cause knee impairments and disability. Knee impairments are related to quadriceps performance – accelerated reaction time (ART) – and disability to performance of daily living activities which is assessed by questionnaires such as the Lysholm knee score. The purposes of this study were to investigate the effect of cross exercise, as

Maria G Papandreou; Evdokia V Billis; Emmanouel M Antonogiannakis; Nikos A Papaioannou

2009-01-01

207

THE EFFECT OF CROSS EXERCISE ON QUADRICEPS STRENGTH IN DIFFERENT KNEE ANGLES AFTER THE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION  

Microsoft Academic Search

PAPANDREOU, M. G. ; PAPAIOANNOU, N. ; ANTONOGIANNAKIS, E. & ZEERIS, H. The effect of cross exercise on quadriceps strength in different knee angles after the anterior cruciate ligament reconstruction. Brazilian Journal of Biomotricity. v. 1, n. 4, p. 123-137, 2007. The patients following ACL reconstruction (ACL-R) demonstrate a substantial quadriceps strength weakness which is more pronounced in the early

Maria G. Papandreou; Nikos Papaioannou; Emmanouel Antonogiannakis; Hlias Zeeris

208

Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee  

Microsoft Academic Search

If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior–posterior knee laxity (A–P

Jonas Isberg; Eva Faxén; Sveinbjörn Brandsson; Bengt I. Eriksson; Johan Kärrholm; Jon Karlsson

2006-01-01

209

The effects of femoral graft placement on in vivo knee kinematics after anterior cruciate ligament reconstruction  

PubMed Central

Achieving anatomical graft placement remains a concern in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to quantify the effect of femoral graft placement on the ability of ACL reconstruction to restore normal knee kinematics under in vivo loading conditions. Two different groups of patients were studied: one in which the femoral tunnel was placed near the anterior and proximal border of the ACL (anteroproximal group, n=12) and another where the femoral tunnel was placed near the center of the ACL (anatomic group, n =10) MR imaging and biplanar fluoroscopy were used to measure in vivo kinematics in these patients during a quasi-static lunge. Patients with anteroproximal graft placement had up to 3.4mm more anterior tibial translation, 1.1mm more medial tibial translation and 3.7° more internal tibial rotation compared to the contralateral side. Patients with anatomic graft placement had motion that more closely replicated that of the intact knee, with anterior tibial translation within 0.8mm, medial tibial translation within 0.5mm, and internal tibial rotation within 1°. Grafts placed anteroproximally on the femur likely provide insufficient restraint to these motions due to a more vertical orientation. Anatomical femoral placement of the graft is more likely to reproduce normal ACL orientation, resulting in a more stable knee. Therefore, achieving anatomical graft placement on the femur is crucial to restoring normal knee function and may decrease the rates of joint degeneration after ACL reconstruction. PMID:21227425

Abebe, E S; Utturkar, G M; Taylor, D C; Spritzer, C E; Kim, J P; Moorman, C T; Garrett, W E; DeFrate, L E

2011-01-01

210

Biomechanical Evaluation of the Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background Recently, many surgeons have chosen the quadriceps tendon (QT) as an autograft for anterior cruciate ligament (ACL) reconstruction. However, there have not been biomechanical studies that quantitatively evaluated knee function after reconstruction using a QT autograft. Purpose To measure the 6 degrees of freedom knee kinematics and in situ graft forces after reconstruction with a QT autograft compared with a quadrupled semitendinosus and gracilis (QSTG) tendon autograft. Study Design Controlled laboratory study. Methods Ten human cadaveric knees (age, 54–64 years) were tested in 3 conditions: (1) intact, (2) ACL deficient, and (3) after ACL reconstruction using a QT or QSTG autograft. With use of a robotic/universal force-moment sensor testing system, knee kinematics and in situ forces in the ACL and autografts were obtained at 5 knee flexion angles under externally applied loads: (1) 134-N anterior tibial load, (2) 134-N anterior tibial load with 200-N axial compression, and (3) 10-N·m valgus and 5-N·m internal tibial torque. Results Under the anterior tibial load, both autografts restored anterior tibial translation to within 2.5 mm of the intact knee and in situ forces to within 20 N of the intact ACL at 15°, 30°, and 60°. Adding compression did not change these findings. With the combined rotatory load, the anterior tibial translation and graft in situ forces were again not significantly different from the intact ACL. There were no significant differences between the grafts under any experimental condition. Conclusion Reconstruction of the ACL with a QT autograft restored knee function to similar levels as that reconstructed with a QSTG autograft under loads simulating clinical examinations. Clinical Relevance The positive biomechanical results of this cadaveric study lend support to the use of a QT autograft for ACL reconstruction, as it could restore knee function immediately after surgery under applied loads that mimic clinical examinations. PMID:24401682

Sasaki, Norihiro; Farraro, Kathryn F.; Kim, Kwang E.; Woo, Savio L-Y.

2014-01-01

211

Cartilage Pressure Distributions Provide a Footprint to Define Female Anterior Cruciate Ligament Injury Mechanisms  

PubMed Central

Background Bone bruises located on the lateral femoral condyle and posterolateral tibia are commonly associated with anterior cruciate ligament (ACL) injuries and may contribute to the high risk for knee osteoarthritis after ACL injury. The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/Hypothesis (1) To analyze tibial and femoral articular cartilage pressure distributions during normal landing and injury simulations, and (2) to evaluate ACL strains for conditions that lead to articular cartilage pressure distributions similar to bone bruise patterns associated with ACL injury. The hypothesis was that combined knee abduction and anterior tibial translation injury simulations would demonstrate peak articular cartilage pressure distributions in the lateral femoral condyle and posterolateral tibia. The corollary hypothesis was that combined knee abduction and anterior tibial translation injury conditions would result in the highest ACL strains. Study Design Descriptive laboratory study. Methods Prospective biomechanical data from athletes who subsequently suffered ACL injuries after testing (n = 9) and uninjured teammates (n = 390) were used as baseline input data for finite element model comparisons. Results Peak articular pressures that occurred on the posterolateral tibia and lateral femoral condyle were demonstrated for injury conditions that had a baseline knee abduction angle of 5°. Combined planar injury conditions of abduction/anterior tibial translation, anterior tibial translation/internal tibial rotation, or anterior tibial translation/external tibial rotation or isolated anterior tibial translation, external tibial rotation, or internal tibial rotation resulted in peak pressures in the posterolateral tibia and lateral femur. The highest ACL strains occurred during the combined abduction/anterior tibial translation condition in the group that had a baseline knee abduction angle of 5°. Conclusion The results of this study support a valgus collapse as the major ACL injury mechanism that results from tibial abduction rotations combined with anterior tibial translation or external or internal tibial rotations. Clinical Relevance Reduction of large multiplanar knee motions that include abduction, anterior translation, and internal/external tibial motions may reduce the risk for ACL injuries and associated bone bruises. In particular, prevention of an abduction knee posture during initial contact of the foot with the ground may help prevent ACL injury. PMID:21487121

Quatman, Carmen E.; Kiapour, Ali; Myer, Gregory D.; Ford, Kevin R.; Demetropoulos, Constantine K.; Goel, Vijay K.; Hewett, Timothy E.

2012-01-01

212

The Effect of Anterior Cruciate Ligament Reconstruction on the Progression of Osteoarthritis  

PubMed Central

Anterior cruciate ligament rupture (ACL) is a common injury, particularly among young sporting adults. Early onset osteoarthritis (OA) can be a devastating and difficult to manage consequence of such an injury. The techniques for reconstructing the ACL are advancing all the time, but the effect that this has on the progression of OA is less well understood. Many factors affect the development of OA following an ACL injury, including direct and indirect trauma to the articular cartilage, associated meniscal injuries, chronic tibiofemoral joint instability, and multiple enzymatic pathways. This review will summarize the current evidence surrounding each of these areas, and describe some of the recent developments that may have an impact on the management of these injuries in the future. PMID:23248720

Norris, Rory; Thompson, Pete; Getgood, Alan

2012-01-01

213

Military movement training program improves jump-landing mechanics associated with anterior cruciate ligament injury risk.  

PubMed

As part of the physical education program at the United States Military Academy, all cadets complete a movement training course designed to develop skills and improve performance in military-related physical tasks as well as obstacle navigation. The purpose of this study was to determine if completion of this course would also result in changes in jump-landing technique that reduce the risk of anterior cruciate ligament (ACL) injury. Analysis of landing mechanics on a two-footed jump landing from a height of 30 cm with a three-dimensional motion capture system synchronized with two force plates revealed both positive and negative changes. Video assessment using the Landing Error Scoring System (LESS) revealed an overall improved landing technique (p=.001) when compared to baseline assessments. The studied military movement course appears to elicit mixed but overall improved lower extremity jump-landing mechanics associated with risk for ACL injury. PMID:23449058

Owens, Brett D; Cameron, Kenneth L; Duffey, Michele L; Vargas, Donna; Duffey, Michael J; Mountcastle, Sally B; Padua, Darin; Nelson, Bradley J

2013-01-01

214

X-ray computed tomography of the anterior cruciate ligament and patellar tendon  

PubMed Central

Summary The effect of phosphotungstic acid (PTA) and iodine solution (IKI) staining was investigated as a method of enhancing contrast in the X-ray computed tomography of porcine anterior cruciate ligaments (ACL) and patellar tendons (PT). We show that PTA enhanced surface contrast, but was ineffective at penetrating samples, whereas IKI penetrated more effectively and enhanced contrast after 70 hours of staining. Contrast enhancement was compared when using laboratory and synchrotron based X-ray sources. Using the laboratory source, PT fascicles were tracked and their alignment was measured. Individual ACL fascicles could not be identified, but identifiable features were evident that were tracked. Higher resolution scans of fascicle bundles from the PT and ACL were obtained using synchrotron imaging techniques. These scans exhibited greater contrast between the fascicles and matrix in the PT sample, facilitating the identification of the fascicle edges; however, it was still not possible to detect individual fascicles in the ACL.

Shearer, Tom; Rawson, Shelley; Castro, Simon Joseph; Balint, Richard; Bradley, Robert Stephen; Lowe, Tristan; Vila-Comamala, Joan; Lee, Peter David; Cartmell, Sarah Harriet

2014-01-01

215

Three-Dimensional Engineered Bone-Ligament-Bone Constructs for Anterior Cruciate Ligament Replacement  

PubMed Central

The anterior cruciate ligament (ACL), a major stabilizer of the knee, is commonly injured. Because of its intrinsic poor healing ability, a torn ACL is usually reconstructed by a graft. We developed a multi-phasic, or bone–ligament–bone, tissue-engineered construct for ACL grafts using bone marrow stromal cells and sheep as a model system. After 6 months in vivo, the constructs increased in cross section and exhibited a well-organized microstructure, native bone integration, a functional enthesis, vascularization, innervation, increased collagen content, and structural alignment. The constructs increased in stiffness to 52% of the tangent modulus and 95% of the geometric stiffness of native ACL. The viscoelastic response of the explants was virtually indistinguishable from that of adult ACL. These results suggest that our constructs after implantation can obtain physiologically relevant structural and functional characteristics comparable to those of adult ACL. They present a viable option for ACL replacement. PMID:21902608

Ma, Jinjin; Smietana, Michael J.; Kostrominova, Tatiana Y.; Wojtys, Edward M.; Larkin, Lisa M.

2012-01-01

216

Factors affecting return to play after anterior cruciate ligament reconstruction: a review of the current literature.  

PubMed

Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities. PMID:25419890

Bauer, Matthew; Feeley, Brian T; Wawrzyniak, John R; Pinkowsky, Gregory; Gallo, Robert A

2014-11-01

217

Resorbable screws versus pins for optimal transplant fixation (SPOT) in anterior cruciate ligament replacement with autologous hamstring grafts: rationale and design of a randomized, controlled, patient and investigator blinded trial [ISRCTN17384369  

PubMed Central

Background Ruptures of the anterior cruciate ligament (ACL) are common injuries to the knee joint. Arthroscopic ACL replacement by autologous tendon grafts has established itself as a standard of care. Data from both experimental and observational studies suggest that surgical reconstruction does not fully restore knee stability. Persisting anterior laxity may lead to recurrent episodes of giving-way and cartilage damage. This might at least in part depend on the method of graft fixation in the bony tunnels. Whereas resorbable screws are easy to handle, pins may better preserve graft tension. The objective of this study is to determine whether pinning of ACL grafts reduces residual anterior laxity six months after surgery as compared to screw fixation. Design/ Methods SPOT is a randomised, controlled, patient and investigator blinded trial conducted at a single academic institution. Eligible patients are scheduled to arthroscopic ACL repair with triple-stranded hamstring grafts, conducted by a single, experienced surgeon. Intraoperatively, subjects willing to engage in this study will be randomised to transplant tethering with either resorbable screws or resorbable pins. No other changes apply to locally established treatment protocols. Patients and clinical investigators will remain blinded to the assigned fixation method until the six-month follow-up examination. The primary outcome is the side-to-side (repaired to healthy knee) difference in anterior translation as measured by the KT-1000 arthrometer at a defined load (89 N) six months after surgery. A sample size of 54 patients will yield a power of 80% to detect a difference of 1.0 mm ± standard deviation 1.2 mm at a two-sided alpha of 5% with a t-test for independent samples. Secondary outcomes (generic and disease-specific measures of quality of life, magnetic resonance imaging morphology of transplants and devices) will be handled in an exploratory fashion. Conclusion SPOT aims at showing a reduction in anterior knee laxity after fixing ACL grafts by pins compared to screws. PMID:15723704

Stengel, Dirk; Matthes, Gerrit; Seifert, Julia; Tober, Volker; Mutze, Sven; Rademacher, Grit; Ekkernkamp, Axel; Bauwens, Kai; Wich, Michael; Casper, Dirk

2005-01-01

218

Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

Purpose The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. Materials and Methods The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. Results In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. Conclusion The technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness. PMID:25323896

Lee, Sang Hyuk; Choi, Jun Young; Kim, Dong Hee; Kang, Bun Jung; Nam, Dae Cheol; Yoon, Hong Kwon

2014-01-01

219

Mechanical stretch increases CCN2/CTGF expression in anterior cruciate ligament-derived cells  

SciTech Connect

Highlights: {yields} CCN2/CTGF localizes to the ligament-to-bone interface, but is not to the midsubstance region of human anterior cruciate ligament (ACL). {yields} Mechanical stretch induces higher increase of CCN2/CTGF gene expression and protein secretion in ACL interface cells compared with ACL midsubstance cells. {yields} CCN2/CTGF treatment stimulates the proliferation of ACL interface cells. -- Abstract: Anterior cruciate ligament (ACL)-to-bone interface serves to minimize the stress concentrations that would arise between two different tissues. Mechanical stretch plays an important role in maintaining cell-specific features by inducing CCN family 2/connective tissue growth factor (CCN2/CTGF). We previously reported that cyclic tensile strain (CTS) stimulates {alpha}1(I) collagen (COL1A1) expression in human ACL-derived cells. However, the biological function and stress-related response of CCN2/CTGF were still unclear in ACL fibroblasts. In the present study, CCN2/CTGF was observed in ACL-to-bone interface, but was not in the midsubstance region by immunohistochemical analyses. CTS treatments induced higher increase of CCN2/CTGF expression and secretion in interface cells compared with midsubstance cells. COL1A1 expression was not influenced by CCN2/CTGF treatment in interface cells despite CCN2/CTGF stimulated COL1A1 expression in midsubstance cells. However, CCN2/CTGF stimulated the proliferation of interface cells. Our results suggest that distinct biological function of stretch-induced CCN2/CTGF might regulate region-specific phenotypes of ACL-derived cells.

Miyake, Yoshiaki [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan) [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Furumatsu, Takayuki, E-mail: matino@md.okayama-u.ac.jp [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Kubota, Satoshi; Kawata, Kazumi [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Ozaki, Toshifumi [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Takigawa, Masaharu [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)

2011-06-03

220

Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion  

Microsoft Academic Search

Sixty-six patients who had meniscal repair at the same time as an ACL reconstruction were followed-up with arthroscopy at an average of 12 months postopera tively. All patients underwent immediate postoperative range of motion from 20° to 90° and began partial weightbearing between the 1 st and 3rd postoperative weeks. The rate of meniscal healing was classified as complete, partial,

Mark S. Buseck; Frank R. Noyes

1991-01-01

221

Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction  

Microsoft Academic Search

The hypothesis proposed in this study was that the initiation of active and passive knee motion within 48 hours of major intraarticular knee ligament surgery would not have the deleterious effects of increasing knee effusion, hemarthrosis, periarticular soft tissue edema, and swelling.We conducted a prospective study with randomized assignment of 18 patients into two groups: 9 patients in the \\

Frank R. Noyes; Robert E. Mangine; Sue Barber

1987-01-01

222

Cell survival following bone-anterior cruciate ligament-bone allograft transplantation: DNA fingerprints, segregation, and collagen morphological analysis of multiple markers in the canine model  

Microsoft Academic Search

Bone-anterior cruciate ligament-bone allograft transplantation has become recognized as a potential solution to reconstruction\\u000a of the anterior cruciate ligament (ACL). The purpose of this study was to determine the time-dependent fibrocyte donor cell\\u000a survival rate after cryopreserved bone-ACL-bone allograft transplantation. Additionally, bony incorporation of the pediculated\\u000a bone plugs was examined. The ability to successfully transplant allogenous ACL fibrocytes and have

M. J. Goertzen; J. Buitkamp; H. Clahsen; M. Möllmann

1998-01-01

223

Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms  

PubMed Central

Background The functional disability and high costs of treating anterior cruciate ligament (ACL) injuries have generated a great deal of interest in understanding the mechanism of noncontact ACL injuries. Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures. Purpose The objectives of this study were (1) to quantify ACL strain under a range of physiologically relevant loading conditions and (2) to evaluate soft tissue and bony injury patterns associated with applied loading conditions thought to be responsible for many noncontact ACL injuries. Study Design Controlled laboratory study. Methods Seventeen cadaveric legs (age, 45 ± 7 years; 9 female and 8 male) were tested utilizing a custom-designed drop stand to simulate landing. Specimens were randomly assigned between 2 loading groups that evaluated ACL strain under either knee abduction or internal tibial rotation moments. In each group, combinations of anterior tibial shear force, and knee abduction and internal tibial rotation moments under axial impact loading were applied sequentially until failure. Specimens were tested at 25° of flexion under simulated 1200-N quadriceps and 800-N hamstring loads. A differential variable reluctance transducer was used to calculate ACL strain across the anteromedial bundle. A general linear model was used to compare peak ACL strain at failure. Correlations between simulated knee injury patterns and loading conditions were evaluated by the ?2 test for independence. Results Anterior cruciate ligament failure was generated in 15 of 17 specimens (88%). A clinically relevant distribution of failure patterns was observed including medial collateral ligament tears and damage to the menisci, cartilage, and subchondral bone. Only abduction significantly contributed to calculated peak ACL strain at failure (P = .002). While ACL disruption patterns were independent of the loading mechanism, tibial plateau injury patterns (locations) were significantly (P = .002) dependent on the applied loading conditions. Damage to the articular cartilage along with depression of the midlateral tibial plateau was primarily associated with knee abduction moments, while cartilage damage with depression of the posterolateral tibial plateau was primarily associated with internal tibial rotation moments. Conclusion The current findings demonstrate the relationship between the location of the tibial plateau injury and ACL injury mechanisms. The resultant injury locations were similar to the clinically observed bone bruises across the tibial plateau during a noncontact ACL injury. These findings indicate that abduction combined with other modes of loading (multiplanar loading) may act to produce ACL injuries. Clinical Relevance A better understanding of ACL injury mechanisms and associated risk factors may improve current preventive, surgical, and rehabilitation strategies and limit the risk of ACL and secondary injuries, which may in turn minimize the future development of posttraumatic osteoarthritis of the knee. PMID:23144366

Levine, Jason W.; Kiapour, Ata M.; Quatman, Carmen E.; Wordeman, Samuel C.; Goel, Vijay K.; Hewett, Timothy E.; Demetropoulos, Constantine K.

2014-01-01

224

Knee laxity after complete anterior cruciate ligament tear: a prospective study over 15 years.  

PubMed

There is limited knowledge of knee laxity in the long term after a complete anterior cruciate ligament (ACL) tear treated without ACL reconstruction. The aim of this study was (1) to describe the clinical course of knee laxity after a complete ACL tear over 15 years, and (2) to study the association between knee laxity and meniscal injuries and the development of knee osteoarthritis (OA). We studied 100 consecutive subjects [mean (SD) age 26 (8) years] presenting with acute ACL injury prospectively. The initial treatment in all subjects was knee rehabilitation without reconstructive surgery. The subjects were examined with Lachman's and pivot-shift tests at baseline, 6 weeks, 3 months, 1 year, 3 years and 15 years after the injury. Sagittal knee laxity was also evaluated with the KT-1000 arthrometer at the 15-year follow-up. During follow-up, 22 subjects were ACL reconstructed due to unacceptable knee instability. There was only a mild remaining knee laxity [median Lachman grade and pivot-shift test value of 1 on a 4-grade scale (0-3)] after 15 years in subjects treated without primary ACL reconstruction. Knees with higher anterior sagittal knee laxity 3 months after the injury had a worse long-term outcome with respect to meniscal injuries and knee OA development. PMID:20673249

Neuman, P; Kostogiannis, I; Fridén, T; Roos, H; Dahlberg, L E; Englund, M

2012-04-01

225

Comparison of score evaluations and instrumented measurement after anterior cruciate ligament reconstruction.  

PubMed

Forty-four patients who had undergone unilateral anterior cruciate ligament reconstructions were evaluated retrospectively with seven different scoring systems (International Knee Documentation Committee, Orthopadische Arbeitsgruppe Knie, Lysholm, Feagin and Blake, Zarins and Rowe, Cincinnati, and Marshall scores). The results varied between systems and therefore lacked reliability. Of the 44 patients, 32 were rated as excellent according to the Cincinnati score while only 3 patients were rated as normal according to the International Knee Documentation Committee form. Good and excellent results were found twice as frequently with the Cincinnati and Lysholm scores compared with the scores of Zarins and Rowe or the International Knee Documentation Committee form. Statistical analysis confirmed this observation and revealed significant differences between the scoring systems. Side-to-side differences using the manual maximum displacement test with the KT-1000 arthrometer revealed good correlation with the International Knee Documentation Committee and the Orthopadische Arbeitsgruppe Knie questionnaires. None of the other scoring systems, which do not measure anterior laxity, produced reasonable correlation with instrumented measurements. We found that certain population-specific factors as well as the distribution of single findings can distort the results of scoring systems. To avoid these interference factors, the patient sample should be homogeneous and selected prospectively and there should be agreement about the value of single findings. PMID:11101108

Hrubesch, R; Rangger, C; Reichkendler, M; Sailer, R F; Gloetzer, W; Eibl, G

2000-01-01

226

Anterior cruciate ligament reconstruction in a patient with Athetoid cerebral palsy: a case report.  

PubMed

Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy.We present herein a previously unreported anterior cruciate ligament (ACL) reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI) and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo's criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An anterior drawer stress radiography of the involved knee at 36 months following surgery showed a 61% anterior translation of the tibia. The preoperative symptoms of instability resolved and the patient expressed a high degree of satisfaction with the result of her surgery. PMID:23031609

Tajima, Takuya; Chosa, Etsuo; Yamamoto, Keitarou; Kawahara, Katsuhiro; Yamaguchi, Nami; Watanabe, Shinji

2012-01-01

227

Multicenter-study of operative treatment of intraligamentous tears of the anterior cruciate ligament in children and adolescents  

Microsoft Academic Search

Tears of the anterior cruciate ligament in skeletally immature patients were operated with four different methods and their outcome compared to each other. Sixty-eight patients (33 males, 35 females), mean 12.5 years, were treated in four different centers from 1984 to 2001. Twenty-eight patients underwent the ACL-reconstruction with hamstring grafts, 16 patients with bone–patella–bone autografts, 12 patients with quadriceps grafts and

F. Gebhard; A. Ellermann; F. Hoffmann; J.-H. Jaeger; N. F. Friederich

2006-01-01

228

Magnetic Resonance Imaging of Bioabsorbable Polylactic Acid Interference Screws During the First 2 Years After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Summary: Bioabsorbable screws composed of poly(L-lactic acid) (PLA) were used for graft fixation and studied prospectively with serial magnetic resonance imaging (MRI) scans at 8, 16, and 24 months after autogenous patellar tendon anterior cruciate ligament (ACL) reconstruction in 10 patients. Conventional spin echo, proton density , and T2-weighted double echo sequences were obtained, as well as T2-weighted fat-saturated fast

William H. Warden; Robert Friedman; Louis M. Teresi; Douglas W. Jackson

1999-01-01

229

Are oral contraceptive use and menstrual cycle phase related to anterior cruciate ligament injury risk in female recreational skiers?  

Microsoft Academic Search

Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries\\u000a in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with\\u000a a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral\\u000a contraceptive use and previous knee injuries. Menstrual history

Gerhard Ruedl; Patrick Ploner; Ingrid Linortner; Alois Schranz; Christian Fink; Renate Sommersacher; Elena Pocecco; Werner Nachbauer; Martin Burtscher

2009-01-01

230

Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament ReconstructionA Randomized Clinical Trial  

Microsoft Academic Search

Background: Because of health care funding and policy changes, there is a need to examine the effects of an evolution toward patient-directed (ie, home-based) rehabilitation programs on clinical outcomes of patients undergoing anterior cruciate ligament reconstruction.Hypothesis: There will be no difference in the effectiveness of a home-based rehabilitation program and a standard physical therapy-supervised rehabilitation program in patients 3 months

John A. Grant; Nicholas G. H. Mohtadi; Murray E. Maitland; Ronald F. Zernicke

2005-01-01

231

Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees  

Microsoft Academic Search

Purpose: For patients who underwent anterior cruciate ligament (ACL) reconstruction and had an unstable bucket-handle tear and no other meniscus lesions or articular damage, we sought to determine if repair of the lateral meniscus was superior to partial meniscectomy with regard to subjective and objective results.Type of Study: Retrospective cohort study.Methods: Between 1982 and 1995, 91 patients met the inclusion

K. Donald Shelbourne; Michael D Dersam

2004-01-01

232

The Effect of Medial Versus Lateral Meniscectomy on the Stability of the Anterior Cruciate Ligament-Deficient Knee  

Microsoft Academic Search

Background: The pivot shift is a dynamic test of knee stability that involves a pathologic, multiplanar motion path elicited by a combination of axial load and valgus force during a knee flexion from an extended position.Purpose: To assess the stabilizing effect of the medial and lateral meniscus on anterior cruciate ligament-deficient (ACL-D) knees during the pivot shift examination.Study Design: Controlled

Volker Musahl; Musa Citak; Padhraig F. OLoughlin; Daniel Choi; Asheesh Bedi; Andrew D. Pearle

2010-01-01

233

Computer-Assisted Anterior Cruciate Ligament Reconstruction: An Evidence-Based Approach of the First 15 Years  

Microsoft Academic Search

In the last 15 years, computer-assisted surgery (CAS) has been used for many purposes during anterior cruciate ligament (ACL) reconstruction, such as tunnel positioning, joint laxity evaluation, and biomechanical studies. This article is an evidence-based literature review of the contribution of such technology to ACL surgery. A search of the PubMed and Medline databases was performed. Articles were classified according

Stefano Zaffagnini; Tiburtius V. Klos; Simone Bignozzi

2010-01-01

234

Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose  Based on biomechanical anatomical studies, double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced\\u000a to achieve better stability in the knee, particularly in respect of rotatory loads. An in vivo, computer-assisted, double-bundle\\u000a (DB) ACL reconstruction is superior to a single-bundle (SB) ACL reconstruction at reducing rotatory, and AP laxities of the\\u000a tibia at 20 degrees of knee flexion and also

Stephane Plaweski; Mathieu Grimaldi; Aurélien Courvoisier; Simon Wimsey

2011-01-01

235

Repair of a complete anterior cruciate tear using prolotherapy: a case report.  

PubMed

OBJECTIVE AND IMPORTANCE: Surgical reconstruction is considered definitive treatment for anterior cruciate ligament (ACL) tears but precise surgical indications are debated. Some patients are reluctant or inappropriate surgical candidates. Prolotherapy is a non-surgical injection therapy for chronic musculoskeletal pain and instability. This case report documents the non-surgical repair of a torn ACL using prolotherapy and at-home exercise. CLINICAL PRESENTATION AND INTERVENTION: The 18 year old female patient sustained a right knee injury during a downhill skiing accident. Magnetic Resonance Imaging (MRI) revealed a high-grade partial versus complete rupture; Lachman exam findings suggested a complete rupture. She deferred surgical treatment. At 21 weeks post-injury, with unstable gait, inability to climb stairs and more than 1 cm anterior drawer test, she consented to undergo prolotherapy injections. She received 7 prolotherapy sessions over a 15 week period. At-home exercises were initiated at the 3(rd) prolotherapy session. RESULTS: The patient improved. Walking on flat ground improved 4 weeks after initiation of prolotherapy; she could ride a stationary bicycle for 30 minutes by 12 weeks. By 15 weeks, the patient had no instability climbing and descending stairs, the anterior drawer test was negative and MRI showed an intact ACL with fibrosis. Subsequently, she returned to full sport activity. CONCLUSIONS: We document the non-surgical repair of a high-grade partial or complete ACL tear using prolotherapy and at-home exercise. Prolotherapy may be an alternative to surgery in carefully selected patients. This report is consistent with findings of recent pilot-level studies and suggests the need for rigorous clinical trials assessing prolotherapy as treatment for ligament and tendon injury in selected patients. PMID:20802815

Grote, Walter; Delucia, Rosa; Waxman, Robert; Zgierska, Aleksandra; Wilson, John; Rabago, David

2009-12-01

236

Serial assessments to determine normalization of gait following anterior cruciate ligament reconstruction.  

PubMed

There is an increased emphasis to identify clinically applicable methods that quantify gait deficits following anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to perform serial gait assessments in a clinical setting to determine whether and when clinical gait parameters normalize in patients following ACLR. The hypothesis was that a clinically available gait treadmill would quantify gait deficits measured at 4 weeks post-reconstruction. The secondary hypothesis was that patients would demonstrate incremental improvements in these gait parameters measured at each interval up to 12 weeks post-reconstruction, and that the objectively measured improvements would correlate to the patient's subjective rating of function. Fifteen subjects, five male and 10 female, who had initial unilateral anterior cruciate ligament injury were selected for this study on the basis of operative data. All subjects were evaluated in a physical therapy clinic within 3 days following ACLR and were enrolled in a standardized rehabilitation program. The dependent gait variables of step length, stance time and gait velocity were measured at 4, 6, 8 and 12 weeks post-ACLR on a commercially available gait treadmill. A 2 x 4 multivariate analysis of variance (2 within factors) with measures for limb involvement (uninvolved and involved) and repeated measures for time (4, 6, 8 and 12 weeks) was used to assess the interactions and the main effects on the gait variables of stance time and step length. The results of this study supported the hypothesis that gait deficits and serial improvements can be objectively quantified in a clinical setting (P<0.001). Specifically, stance time, step length and gait velocity deficits evaluated at 4 weeks showed significant improvements at the measured intervals. Step length normalized at week 8. Stance time and gait velocity reached normal levels at the 12-week time interval. Subjective activity of daily living scores (ADLS) also improved following the 12-week rehabilitation, from 53+/-17% to a mean score of 88+/-11% (P<0.001). ADLS scores significantly correlated to step length (R=0.63) and stance time (R=0.53) in the involved limb. Self-selected gait velocity also correlated to ADLS scores and significantly predicted 49% of the variance in the subjective outcome measure. A clinically available gait treadmill can be used to quantify gait deficits and improvements following ACLR. Serial assessments of walking gait may aid clinicians to identify and target deficits in their patients during rehabilitation. PMID:18510594

Minning, S J; Myer, G D; Mangine, R E; Eifert-Mangine, M; Colosimo, A J

2009-08-01

237

A matched pairs comparison of single- versus double-bundle anterior cruciate ligament reconstructions, clinical results and manual laxity testing  

Microsoft Academic Search

Purpose  To compare the subjective clinical results as well as manual anterior and rotational stability in patients treated with either\\u000a single- (SB) or double-bundle (DB) anterior cruciate ligament (ACL) reconstructions.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Sixty-four patients who had undergone SB or DB hamstring ACL reconstruction with hamstrings were included in a retrospective\\u000a matched pair analysis. At follow-up IKDC subjective, CKS, KOOS, CKS and a visual

R. SieboldT; T. P. Branch; H. I. Freedberg; C. A. Jacobs

238

Electrophysiological Assessment of Injury to the Infra-patellar Branch(es) of the Saphenous Nerve during Anterior Cruciate Ligament Reconstruction Using Medial Hamstring Auto-grafts: Vertical versus Oblique Harvest Site Incisions  

PubMed Central

Background It was suggested that the direction of incision for medial hamstring tendons harvesting influences the incidence of injury to the infrapatellar branch of the saphenous nerve (IPBSN), a common complication following arthroscopically-assisted anterior cruciate ligament reconstruction (ACLR). Objectives The main purpose of current study was to compare the incidence of IPBSN injury between vertical and oblique incisions utilizing electrophysiological evaluation. Patients and Methods There were 60 patients underwent arthroscopically-assisted ACLR assigned to two equal vertical or oblique incision groups, randomly. One year postoperatively, the patients were electrophysiologically examined to detect whether IPBSN is injured. The Lysholm score was completed. The patients' satisfaction with surgical outcomes determined utilizing visual analogue scale (VAS). Finally, two groups were compared and the effect of IPBSN injury on function and satisfaction was investigated. Results The incidence of IPBSN injury was higher in the vertical group (4 patients vs. 10 patients), but the difference was not statistically significant. The mean of Lysholm and VAS scores were the same. Also, the mean of Lysholm score was the same in patients with and without IPBSN injury. However, patients without IPBSN injury were more satisfied (8.9 ± 9 vs. 7.4 ± 1.1; P < 0.001). Conclusions IPBSN injury is a common complication following arthroscopically-assisted ACLR and, if not significant, oblique direction of the incision is associated with decreased incidence of the injury. IPBSN injury has no effect on the function but because of the disturbance with patients' satisfaction, authors believe the oblique incision is preferable to avoid the nerve injury during medial hamstring tendons harvesting. PMID:24693521

Tavakoli Darestani, Reza; Bagherian Lemraski, Mohammad Mehdi; Hosseinpour, Mehrdad; Kamrani-Rad, Amin

2013-01-01

239

An Ambulatory Method of Identifying Anterior Cruciate Ligament Reconstructed Gait Patterns  

PubMed Central

The use of inertial sensors to characterize pathological gait has traditionally been based on the calculation of temporal and spatial gait variables from inertial sensor data. This approach has proved successful in the identification of gait deviations in populations where substantial differences from normal gait patterns exist; such as in Parkinsonian gait. However, it is not currently clear if this approach could identify more subtle gait deviations, such as those associated with musculoskeletal injury. This study investigates whether additional analysis of inertial sensor data, based on quantification of gyroscope features of interest, would provide further discriminant capability in this regard. The tested cohort consisted of a group of anterior cruciate ligament reconstructed (ACL-R) females and a group of non-injured female controls, each performed ten walking trials. Gait performance was measured simultaneously using inertial sensors and an optoelectronic marker based system. The ACL-R group displayed kinematic and kinetic deviations from the control group, but no temporal or spatial deviations. This study demonstrates that quantification of gyroscope features can successfully identify changes associated with ACL-R gait, which was not possible using spatial or temporal variables. This finding may also have a role in other clinical applications where small gait deviations exist. PMID:24451464

Patterson, Matthew R.; Delahunt, Eamonn; Sweeney, Kevin T.; Caulfield, Brian

2014-01-01

240

Predictors of Adherence to Home Rehabilitation Exercises Following Anterior Cruciate Ligament Reconstruction  

PubMed Central

Purpose/Objective Although home exercises are commonly prescribed following anterior cruciate ligament (ACL) reconstruction and are considered important in obtaining successful rehabilitation outcomes, little is known about factors associated with the completion of such exercises. Consequently, this study was designed to identify predictors of adherence to home rehabilitation exercises after ACL surgery. Research Method/Design Participants (33 women, 58 men) completed indices of athletic identity, neuroticism, optimism, and pessimism before ACL surgery and measures of daily pain, negative mood, stress, and home exercise completion for 42 days postoperatively. Results Participants reported a high level of adherence to the prescribed regimen. Home exercise completion increased significantly over time as the number of sets of prescribed home exercises declined. Personal factors were not predictive of home exercise completion. Participants completed fewer home exercises on days when they experienced more stress or negative mood. Conclusions/Implications Day-to-day variations in negative mood and stress may contribute to adherence to prescribed home exercises. PMID:23438001

Brewer, Britton W.; Cornelius, Allen E.; Van Raalte, Judy L.; Tennen, Howard; Armeli, Stephen

2014-01-01

241

Telemetry system for monitoring anterior cruciate ligament graft forces in vivo  

NASA Astrophysics Data System (ADS)

Quantifying changes in the tension of an anterior cruciate ligament (ACL) graft in vivo during rehabilitative exercises is vital for developing the optimal rehabilitation for patients who have had reconstructive surgery. The purpose of this project was to design, built, and test a telemetry system that can measure the in vivo ACL graft tension postoperatively. A commercially available fixation device was modified to sense the graft tension, house electronic components, transmit an output signal, and pass the power generating signal. A transcutaneous inductive link was used to power the implanted telemetry electronics. The current difference technique was used to measure changes in two strain gages that monitored shear strain developed on the femoral fixation device by the ACL graft. This current regulated a frequency modulated output signal and transmitted it, by using the ionic properties of body tissue as the medium, to external EMG surface electrodes. A signal conditioning board detected and converted the output to an analog voltage for collection by a computer data acquisition system. A performance evaluation demonstrated that the telemetry system either met or exceeded al of the criteria necessary for the application.

McKee, Eric L.; Hull, Maury L.; Howell, Stephen M.

1997-02-01

242

Anterior cruciate ligament injury after more than 20 years. II. Concentric and eccentric knee muscle strength.  

PubMed

The long-term consequences on knee muscle strength some decades after rupture of the anterior cruciate ligament (ACL) are not established. The aims of our study were to examine peak torque more than 20 years after ACL injury and to compare their knee muscle strength to that of healthy controls. We tested 70 individuals with unilateral ACL injury 23?±?2 years after injury, whereof 33 (21 men) were treated with physiotherapy in combination with ACL reconstruction (ACLR ) and 37 (23 men) with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls (21 men). A Kin-Com(®) dynamometer (90°/s) was used to measure peak torque in knee flexion and extension in both concentric and eccentric contractions. Knee extension peak torque, concentric and eccentric, was ?10% lower for the injured leg compared with the non-injured leg for both ACLR (P?

Tengman, E; Brax Olofsson, L; Stensdotter, A K; Nilsson, K G; Häger, C K

2014-12-01

243

Knee flexor strength following anterior cruciate ligament reconstruction with the semitendinosus and gracilis tendons.  

PubMed

Knee flexor strength recovery following anterior cruciate ligament reconstruction with the doubled semitendinosus and gracilis tendons was assessed for up to 12 months post-surgery. Twelve patients were followed up, four at 3 months, five at 6 months and three at 12 months post-surgery. Knee flexor moment was recorded using the Biodex System-3 isokinetic dynamometer. Three sets of five repetitions of reciprocal eccentric/ concentric knee flexion contractions were carried out with each set at 1.05, 2.09 or 3.14 rad x s(-1). T-tests were used to test for significant differences between and within groups. The uninjured leg produced greater average peak moments than the injured leg; significant differences (p < 0.05) were seen between the legs at 1.05 rad x s(-1) for the 3-month group concentrically, and all three groups eccentrically. There was no significant difference (p > 0.05) between groups for the percentage deficit between legs. On average, a 23% deficit in average peak moment was still evident at 12 months both eccentrically and concentrically at 1.05 rad x s(-1). Taken as a whole this evidence suggests that there is a deficit in knee flexor strength up to at least 12 months post-surgery following doubled semitendinosus and gracilis tendon graft reconstruction even after a full rehabilitation protocol. PMID:11719899

Coombs, R; Cochrane, T

2001-11-01

244

Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor  

NASA Astrophysics Data System (ADS)

Diagnosis method of anterior cruciate ligament (ACL) using body-mounted sensor is discussed. A wide variety of diagnosis method such as Pivot Shift Test (PST), Lachman Test and monitoring of jump motion (JT) are applied to examine the injured ACL. These methods, however, depend on the ability and the experience of examiner. The proposed method numerically provides three dimensional translation and rotation of the knee by using a newly developed 3D sensor. The 3D sensor is composed of three accelerometers and three gyroscopes. Measured acceleration of the knee during the examination is converted to the fixed system of coordinate according the acceleration of gravity and 3D rotation of the sensor, and is numerically integrated to derive 3D trajectory and rotation angle around the tibia. The experimental results of JT suggest that unsymmetrical movement of rotation angle of the tibia and sudden movement of estimated 3D trajectory show instability of knee joint. From the results of PST analysis, it is observed that the tibial angular velocity around the flexed position changes 41.6 [deg/s] at the injured side and 21.7 [deg/s] at the intact side. This result suggests the reposition of injured knee from subluxation.

Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

2007-12-01

245

Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks.  

PubMed

The purpose of this study was to determine whether mechanical adaptations were present in patients with anterior cruciate ligament (ACL)-deficient knees during high-demand activities. Twenty-two subjects with unilateral ACL deficiency (11 males and 11 females, 19.6 months after injury) performed five different activities at a comfortable speed (level walking, ascending and descending steps, jogging, jogging to a 90-degree side cutting toward the opposite direction of the tested side). Three-dimensional knee kinematics for the ACL-deficient knees and uninjured contralateral knees were evaluated using the Point Cluster Technique. There was no significant difference in knee flexion angle, but an offset toward the knee in less valgus and more external tibial rotation was observed in the ACL-deficient knee. The tendency was more obvious in high demand motions, and a significant difference was clearly observed in the side cutting motions. These motion patterns, with the knee in less valgus and more external tibial rotation, are proposed to be an adaptive movement to avoid pivot shift dynamically, and reveal evidence in support of a dynamic adaptive motion occurring in ACL-deficient knees. PMID:24837218

Takeda, Kentaro; Hasegawa, Takayuki; Kiriyama, Yoshimori; Matsumoto, Hideo; Otani, Toshiro; Toyama, Yoshiaki; Nagura, Takeo

2014-07-18

246

Using ground reaction force to predict knee kinetic asymmetry following anterior cruciate ligament reconstruction.  

PubMed

Asymmetries in sagittal plane knee kinetics have been identified as a risk factor for anterior cruciate ligament (ACL) re-injury. Clinical tools are needed to identify the asymmetries. This study examined the relationships between knee kinetic asymmetries and ground reaction force (GRF) asymmetries during athletic tasks in adolescent patients following ACL reconstruction (ACL-R). Kinematic and GRF data were collected during a stop-jump task and a side-cutting task for 23 patients. Asymmetry indices between the surgical and non-surgical limbs were calculated for GRF and knee kinetic variables. For the stop-jump task, knee kinetics asymmetry indices were correlated with all GRF asymmetry indices (P?

Dai, B; Butler, R J; Garrett, W E; Queen, R M

2014-12-01

247

Rye grass is associated with fewer non-contact anterior cruciate ligament injuries than bermuda grass  

PubMed Central

Objective: To assess the contribution of ground variables including grass type to the rate of anterior cruciate ligament (ACL) injury in the Australian Football League (AFL), specifically which factors are primarily responsible for previously observed warm season and early season biases for ACL injuries. Methods: Grass types used at the major AFL venues from 1992 to 2004 were established by consultation with ground managers, and ground hardness and other weather variables were measured prospectively. Results: There were 115 ACL injuries occurring in matches during the survey time period, 88 with a non-contact mechanism. In multivariate analysis, use of bermuda (couch) grass as opposed to rye grass, higher grade of match, and earlier stage of the season were independent risk factors for non-contact ACL injury. Ground hardness readings did not show a significant association with ACL injury risk, whereas weather variables of high evaporation and low prior rainfall showed univariate association with injury risk but could not be entered into a logistic regression equation. Discussion: Rye grass appears to offer protection against ACL injury compared with bermuda (couch) grass fields. The likely mechanism is reduced "trapping" of football boots by less thatch. Grass species as a single consideration cannot fully explain the ACL early season bias, but is probably responsible for the warm season bias seen in the AFL. Weather variables previously identified as predictors are probably markers for predominance of bermuda over rye grass in mixed fields. PMID:16183765

Orchard, J; Chivers, I; Aldous, D; Bennell, K; Seward, H

2005-01-01

248

Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis  

PubMed Central

Background The decision whether to treat conservatively or reconstruct surgically a torn anterior cruciate ligament (ACL) is an ongoing subject of debate. The high prevalence and associated public health burden of torn ACL has led to continuous efforts to determine the best therapeutic approach. A critical evaluation of benefits and expenditures of both treatment options as in a cost effectiveness analysis seems well-suited to provide valuable information for treating physicians and healthcare policymakers. Methods A literature review identified four of 7410 searched articles providing sufficient outcome probabilities for the two treatment options for modeling. A transformation key based on the expert opinions of 25 orthopedic surgeons was used to derive utilities from available evidence. The cost data for both treatment strategies were based on average figures compiled by Orthopaedic University Hospital Balgrist and reinforced by Swiss national statistics. A decision tree was constructed to derive the cost-effectiveness of each strategy, which was then tested for robustness using Monte Carlo simulation. Results Decision tree analysis revealed a cost effectiveness of 16,038 USD/0.78 QALY for ACL reconstruction and 15,466 USD/0.66 QALY for conservative treatment, implying an incremental cost effectiveness of 4,890 USD/QALY for ACL reconstruction. Sensitivity analysis of utilities did not change the trend. Conclusion ACL reconstruction for reestablishment of knee stability seems cost effective in the Swiss setting based on currently available evidence. This, however, should be reinforced with randomized controlled trials comparing the two treatment strategies. PMID:22098703

2011-01-01

249

Rationale and Clinical Techniques for Anterior Cruciate Ligament Injury Prevention Among Female Athletes  

PubMed Central

Objective: To present the rationale and detailed techniques for the application of exercises targeted to prevent anterior cruciate ligament (ACL) injury in high-risk female athletes. Background: Female athletes have a 4- to 6-fold increased risk for ACL injury compared with their male counterparts playing at similar levels in the same sports. The increased ACL injury risk coupled with greater sports participation by young women over the last 30 years (9-fold increase in high school and 5-fold increase in collegiate sports) has generated public awareness and fueled several sex-related mechanistic and interventional investigations. These investigations provide the groundwork for the development of neuromuscular training aimed at targeting identified neuromuscular imbalances to decrease ACL injury risk. Description: After the onset of puberty, female athletes may not have a neuromuscular spurt to match their similar, rapid increase in growth and development. The lack of a natural neuromuscular adaptation may facilitate the development of neuromuscular imbalances that increase the risk for ACL injury. Dynamic neuromuscular analysis training provides the methodologic approach for identifying high-risk individuals and the basis of using interventions targeted to their specific needs. Clinical Advantages: Dynamic neuromuscular training applied to the high-risk population may decrease ACL injury risk and help more female athletes enjoy the benefits of sports participation without the long-term disabilities associated with injury. PMID:15592608

Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

2004-01-01

250

Lower-limb dominance as a possible etiologic factor in noncontact anterior cruciate ligament tears.  

PubMed

The purpose of this study was to determine if lower-limb dominance is a potential etiologic factor in noncontact anterior cruciate ligament (ACL) tears. A multicenter retrospective case analysis was performed. In each of the participating centers, patients were questioned to confirm a noncontact ACL injury and to determine lower-limb dominance. Three hundred and two subjects (149 males and 153 females) who presented with unilateral noncontact ACL tears participated in the study. The relationships between limb dominance, side of injury, and gender were analyzed. There was no significant correlation between the side of injury and the dominant limb for kicking (p = 0.30). There was no significant gender effect of the relationship between side of injury and dominant limb (p = 0.36). When assessing gender types and side of ACL tears, females showed a strong trend toward tearing the left ACL more frequently than the right (p = 0.06). No such trend existed for males. The results of this study indicate that there is no significant relationship between lower-limb dominance and the likelihood of sustaining a noncontact ACL tear. However, the strong trend toward females tearing their left ACLs more often than their right ACLs warrants further investigation to determine what neuromuscular asymmetries may exist between the right and left lower limbs. PMID:17313288

Negrete, Rodney J; Schick, Elizabeth A; Cooper, Joshua P

2007-02-01

251

Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: basketball.  

PubMed

The purpose of this paper is to outline the final, functional phases of rehabilitation that address exercises, drills, and return-to-play criteria for the sport of basketball, following anterior cruciate ligament (ACL) reconstruction. ACL injuries can be debilitating and affect the quality of life for recreational and elite athletes alike. Tears of the ACL are common in both male and female basketball players, with a higher incidence rate in females. Incidence of a retear to the existing graft or contralateral knee within 5 years of ACL reconstruction with patellar tendon autograft in young (less than 18 to 25 years of age), active basketball players can be as high as 52%. Reducing the number of ACL injuries or reinjury, of which there are an estimated 80 000 per year at an associated cost of over a billion dollars, can have significant potential long-term fiscal and health benefits. Following surgical reconstruction of the ACL, implementing a tailored rehabilitation protocol can ensure a successful return to sport. When searching the literature for such protocols, clinicians may struggle to find specific exercises, drills, and return-to-play criteria for particular sports. The intent of this manuscript is to present such a rehabilitation protocol for basketball. PMID:22465899

Waters, Eric

2012-04-01

252

Evaluation, management, rehabilitation, and prevention of anterior cruciate ligament injury: current concepts.  

PubMed

The anterior cruciate ligament (ACL) is essential for both static and dynamic stability of the knee. It is commonly injured during sports activities by noncontact mechanisms that include landing with the knee in valgus and extension, sudden deceleration, change of direction, and rotation. Several modifiable and nonmodifiable risk factors predispose athletes to this injury, especially women. Early diagnosis, treatment directed to protect secondary knee structures, and rehabilitation play an important role in the management of ACL injury. Despite a lack of scientifically validated and published guidelines to help clinicians decide between conservative or surgical treatment, criteria such as pain, recurrent instability, injury to secondary structures, and desired level of activity should be considered. Accelerated rehabilitation protocols for patients who have and have not undergone an operation are available and recommended with goals of reducing complications such as recurrent injury, loss of motion, residual weakness, and associated osteoarthritis. However, injury prevention protocols could be the next big step in management of ACL injury with emphasis on reducing modifiable risk factors in susceptible individuals who participate in sports. PMID:20970763

Micheo, William; Hernández, Liza; Seda, Carlos

2010-10-01

253

Collagen-Platelet Composite Enhances Biomechanical and Histologic Healing of the Porcine Anterior Cruciate Ligament  

PubMed Central

Background The anterior cruciate ligament (ACL) fails to heal after traumatic rupture. Furthermore, large-animal models have recently shown that 1-month functional ACL healing is augmented after suture repair when a bioactive scaffold is placed in the tear site. Hypothesis At the time of suture repair, placement of a bioactive scaffold in the ACL wound site would improve the structural properties of the tissue. Study Design Controlled laboratory study. Methods Twenty-seven knees in immature pigs underwent ACL transection and suture repair. A collagen-platelet composite (CPC) was used to supplement the repair in 14 knees. Knees were harvested at 4 weeks, 6 weeks, and 3 months. Mechanical testing and histologic analysis were performed. Results The addition of a CPC to a suture repair resulted in improvements in yield load and linear stiffness of the repair tissue at 3 months, as well as a significant increase in cell density. A reduction in yield load and stiffness occurred at the 6-week time point in both groups, a phase when revascularization was noted. Conclusion The addition of a CPC to a suture repair enhanced the structural properties of the ACL, and the improvement was associated with increased cellularity within the healing ligament. Clinical Relevance The addition of a bioactive scaffold to the wound site improved the functional healing of the ACL after suture repair. The decreased repair strength during revascularization may indicate a need to protect the repair site through this period. PMID:19940313

Joshi, Shilpa M.; Mastrangelo, Ashley N.; Magarian, Elise M.; Fleming, Braden C.; Murray, Martha M.

2010-01-01

254

Current practice variations in the management of anterior cruciate ligament injuries in Croatia  

PubMed Central

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature. PMID:24147268

Mahnik, Alan; Mahnik, Silvija; Dimnjakovic, Damjan; Curic, Stjepan; Smoljanovic, Tomislav; Bojanic, Ivan

2013-01-01

255

An ambulatory method of identifying anterior cruciate ligament reconstructed gait patterns.  

PubMed

The use of inertial sensors to characterize pathological gait has traditionally been based on the calculation of temporal and spatial gait variables from inertial sensor data. This approach has proved successful in the identification of gait deviations in populations where substantial differences from normal gait patterns exist; such as in Parkinsonian gait. However, it is not currently clear if this approach could identify more subtle gait deviations, such as those associated with musculoskeletal injury. This study investigates whether additional analysis of inertial sensor data, based on quantification of gyroscope features of interest, would provide further discriminant capability in this regard. The tested cohort consisted of a group of anterior cruciate ligament reconstructed (ACL-R) females and a group of non-injured female controls, each performed ten walking trials. Gait performance was measured simultaneously using inertial sensors and an optoelectronic marker based system. The ACL-R group displayed kinematic and kinetic deviations from the control group, but no temporal or spatial deviations. This study demonstrates that quantification of gyroscope features can successfully identify changes associated with ACL-R gait, which was not possible using spatial or temporal variables. This finding may also have a role in other clinical applications where small gait deviations exist. PMID:24451464

Patterson, Matthew R; Delahunt, Eamonn; Sweeney, Kevin T; Caulfield, Brian

2014-01-01

256

Stereoscopic filming for investigating evasive side-stepping and anterior cruciate ligament injury risk  

NASA Astrophysics Data System (ADS)

Non-contact anterior cruciate ligament (ACL) injuries are serious and debilitating, often resulting from the performance of evasive sides-stepping (Ssg) by team sport athletes. Previous laboratory based investigations of evasive Ssg have used generic visual stimuli to simulate realistic time and space constraints that athletes experience in the preparation and execution of the manoeuvre. However, the use of unrealistic visual stimuli to impose these constraints may not be accurately identifying the relationship between the perceptual demands and ACL loading during Ssg in actual game environments. We propose that stereoscopically filmed footage featuring sport specific opposing defender/s simulating a tackle on the viewer, when used as visual stimuli, could improve the ecological validity of laboratory based investigations of evasive Ssg. Due to the need for precision and not just the experience of viewing depth in these scenarios, a rigorous filming process built on key geometric considerations and equipment development to enable a separation of 6.5 cm between two commodity cameras had to be undertaken. Within safety limits, this could be an invaluable tool in enabling more accurate investigations of the associations between evasive Ssg and ACL injury risk.

Lee, Marcus J. C.; Bourke, Paul; Alderson, Jacqueline A.; Lloyd, David G.; Lay, Brendan

2010-02-01

257

Repair of a torn medial meniscus with an anteromedial meniscofemoral ligament in an anterior cruciate ligament-injured knee.  

PubMed

We report a rare case of longitudinal tear of the anterior segment of the medial meniscus in association with the anteromedial meniscofemoral ligament (AMMFL) in an anterior cruciate ligament-injured knee. The tear was repaired, and the anterior horn was transferred to the tibia using the pull-out technique after excising the AMMFL. Repeat arthroscopy performed 7 months postoperatively revealed that the medial meniscus had completely healed and the anterior horn was firmly fixed to the tibia. Two years after the surgery, the patient could play basketball without any symptom. A posteroanterior flexion weight-bearing radiograph did not show any narrowing of the medial joint space. Considering the excellent healing observed in this case, preservation of the meniscus should be considered despite an association between a torn meniscus and an anomalous insertion. PMID:21127836

Hamada, Masayuki; Miyama, Takahide; Nagayama, Yoshihiro; Shino, Konsei

2011-05-01

258

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort  

PubMed Central

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

2013-01-01

259

Graft isometricity in unitunnel anterior cruciate ligament reconstruction: analysis of influential factors using a radiographic model.  

PubMed

A radiographic model was developed to investigate the influence of three surgical variables on the change in attachment point distance (CAPD) of a hypothetical graft using the unitunnel technique of anterior cruciate ligament (ACL) reconstruction. Using three different femoral target points, we tested the hypothesis that varying the angle of knee flexion between 70 degrees and 110 degrees and varying the tibial starting point over a 4-cm range do not result in a significant variation in CAPD. We also tested the hypothesis that the CAPD from 0 degrees to 135 degrees is greater than the CAPD from 0 degrees to 90 degrees. There was a statistically significant correlation (r = 0.8465, P < 0.0001) between radiographically estimated and isometer-measured values of CAPD. The tibial starting point and the femoral target point were found to affect the CAPD significantly (P < 0.005). A more proximal tibial starting point was associated with a lower CAPD. Both the center of the anatomic femoral attachment of the ACL, and a point 1 mm medial to the junction of the roof and lateral wall of the femoral intercondylar notch and 6 mm anterior to its posterior margin, were associated with lower CAPD values than a target point 5 mm superior and posterior to the center of the femoral ACL attachment. The angle of knee flexion did not significantly affect the CAPD. The CAPD [0 degrees-135 degrees] was significantly greater than the CAPD [0 degree-90 degrees] for all combinations of variables (P < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8536017

Feller, J A; Glisson, R R; Seaber, A V; Feagin, J A; Garrett, W E

1993-01-01

260

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics  

PubMed Central

Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint. When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15° and 90° of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly—as was expected on the basis of the increased anterior tibial translation—as well as laterally on the surface of the tibial plateau. The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom. PMID:19182035

Van de Velde, Samuel K.; Gill, Thomas J.; Li, Guoan

2009-01-01

261

Histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits  

PubMed Central

Polyethylene terephthalate LARS ligament were the remnant of LARS ligament used for repairing posterior cruciate ligament obtained from operation. We want to study histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits. Therefore, we replaced the original ACL with polyethylene terephthalate LARS ligament which was covering with the remnant of ACL in 9 rabbits (L-LARS group), while just only polyethylene terephthalate LARS ligament were transplanted in 3 rabbits (LARS group) with the remnant of ACL. Compared with group LARS, inflammatory cell reaction and foreign body reaction were more significant in group L-LARS. Moreover, electron microscopy investigation showed the tissue near LARS fibers was highly cellular with a matrix of thin collagen fibrils (50-100 nm) in group L-LARS. These above findings suggest the polyethylene terephthalate LARS ligament possess the high biocompatibility, which contributes to the polyethylene terephthalate LARS covered with recipient connective tissues. PMID:25356104

Yu, Shao-Bin; Yang, Rong-Hua; Zuo, Zhong-Nan; Dong, Qi-Rong

2014-01-01

262

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment  

PubMed Central

Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n=5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n=5). The right ACL served as control. After 12 weeks of healing, anterior–posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior–posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30° in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1±8.1?N/mm vs. 41.9±18.0?N/mm [p>0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising. PMID:23725556

Geel, Jurre; Schulze, Martin; Raschke, Michael J.; Woo, Savio L-Y.; van Dijk, C. Niek; Blankevoort, Leendert

2013-01-01

263

Reliability and validity of DPA-1 testing after anterior cruciate ligament reconstruction.  

PubMed

There is a lack of equipment and methods for the reliable and valid measurements of human neuromuscular control. To overcome this limitation, an analyzer of dynamic parameters (DPA-1) of human hand and leg movements was constructed by Kaunas University of Technology and "Katra" engineers in collaboration with the Lithuanian Academy of Physical Education. The aim of the study was to determine the reliability and validity of the tests performed on the DPA-1 in healthy and injured subjects after the anterior cruciate ligament (ACL) reconstruction surgery. MATERIAL AND METHODS. The men who had undergone a unilateral ACL reconstruction (n=17, on the average 3.8 months [SD, 2.1] after the surgery) and healthy untrained men (n=17) performed the research protocol twice within 24 hours in between. Average reaction time, mean and maximal movement speed, time to reach maximal speed, and movement distance of the right and left feet for the patients and of the dominant foot for the healthy subjects using the DPA-1 as well as the scores of isokinetic muscle strength and self-assessment tests were registered. RESULTS. There was a significantly reduced concentric peak torque on the injured knee compared with the uninjured knee during knee extension, and the mean score of the Lysholm scale for the injured knee was 69.1 (SD, 13.7) (P<0.05, compared between legs). The test-retest reliability for all the DPA-1 tests varied from 0.68 to 0.94 (P<0.05). However, there were no significant differences in most variables measured by the DPA-1 between injured knee, uninjured knee, and control knee. CONCLUSIONS. The results revealed low validity of the DPA-1 tests for the evaluation of patients following ACL surgery, despite the reliability of these tests varied from moderate to very high. PMID:22491385

Kamandulis, Sigitas; Kanavolait?, Agn?; Skurvydas, Albertas; Škikas, Laimutis; Streckis, Vytautas; Mickevi?ien?, Dalia; Puk?nas, Kazimieras; Jurevi?ien?, Vilma; Masiulis, Nerijus

2012-01-01

264

Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function.  

PubMed

Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23?±?2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR ), and 37 treated with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P?

Tengman, E; Brax Olofsson, L; Nilsson, K G; Tegner, Y; Lundgren, L; Häger, C K

2014-12-01

265

A multi-scale structural study of the porcine anterior cruciate ligament tibial enthesis.  

PubMed

Like the human anterior cruciate ligament (ACL), the porcine ACL also has a double bundle structure and several biomechanical studies using this model have been carried out to show the differential effect of these two bundles on macro-level knee joint function. It is hypothesised that if the different bundles of the porcine ACL are mechanically distinct in function, then a multi-scale anatomical characterisation of their individual enthesis will also reveal significant differences in structure between the bundles. Twenty-two porcine knee joints were cleared of their musculature to expose the intact ACL following which ligament-bone samples were obtained. The samples were fixed in formalin followed by decalcification with formic acid. Thin sections containing the ligament insertion into the tibia were then obtained by cryosectioning and analysed using differential interference contrast (DIC) optical microscopy and scanning electron microscopy (SEM). At the micro-level, the anteromedial (AM) bundle insertion at the tibia displayed a significant deep-rooted interdigitation into bone, while for the posterolateral (PL) bundle the fibre insertions were less distributed and more focal. Three sub-types of enthesis were identified in the ACL and related to (i) bundle type, (ii) positional aspect within the insertion, and (iii) specific bundle function. At the nano-level the fibrils of the AM bundle were significantly larger than those in the PL bundle. The modes by which the AM and PL fibrils merged with the bone matrix fibrils were significantly different. A biomechanical interpretation of the data suggests that the porcine ACL enthesis is a specialized, functionally graded structural continuum, adapted at the micro-to-nano scales to serve joint function at the macro level. PMID:24697495

Zhao, Lei; Thambyah, Ashvin; Broom, Neil D

2014-06-01

266

Mesenchymal Stem Cell Characteristics of Human Anterior Cruciate Ligament Outgrowth Cells  

PubMed Central

When ruptured, the anterior cruciate ligament (ACL) of the human knee has limited regenerative potential. However, the goal of this report was to show that the cells that migrate out of the human ACL constitute a rich population of progenitor cells and we hypothesize that they display mesenchymal stem cell (MSC) characteristics when compared with adherent cells derived from bone marrow or collagenase digests from ACL. We show that ACL outgrowth cells are adherent, fibroblastic cells with a surface immunophenotype strongly positive for cluster of differentiation (CD)29, CD44, CD49c, CD73, CD90, CD97, CD105, CD146, and CD166, weakly positive for CD106 and CD14, but negative for CD11c, CD31, CD34, CD40, CD45, CD53, CD74, CD133, CD144, and CD163. Staining for STRO-1 was seen by immunohistochemistry but not flow cytometry. Under suitable culture conditions, the ACL outgrowth-derived MSCs differentiated into chondrocytes, osteoblasts, and adipocytes and showed capacity to self-renew in an in vitro assay of ligamentogenesis. MSCs derived from collagenase digests of ACL tissue and human bone marrow were analyzed in parallel and displayed similar, but not identical, properties. In situ staining of the ACL suggests that the MSCs reside both aligned with the collagenous matrix of the ligament and adjacent to small blood vessels. We conclude that the cells that emigrate from damaged ACLs are MSCs and that they have the potential to provide the basis for a superior, biological repair of this ligament. PMID:21247268

Kunz, Manuela; Prager, Patrick; Barthel, Thomas; Jakob, Franz; Noth, Ulrich; Murray, Martha M.; Evans, Christopher H.; Porter, Ryan M.

2011-01-01

267

Quadriceps Activation Failure After Anterior Cruciate Ligament Rupture Is Not Mediated by Knee Joint Effusion  

PubMed Central

STUDY DESIGN Descriptive prospective cohort study. OBJECTIVES To investigate the relationships between knee joint effusion, quadriceps activation, and quadriceps strength. These relationships may help clinicians better identify impaired quadriceps activation. BACKGROUND After anterior cruciate ligament (ACL) injury, the involved quadriceps may demonstrate weakness. Experimental data have shown that quadriceps activation and strength may be directly mediated by intracapsular joint pressure created by saline injection. An inverse relationship between quadriceps activation and the amount of saline injected has been reported. This association has not been demonstrated for traumatic effusion. We hypothesized that traumatic joint effusion due to ACL rupture and postinjury quadriceps strength would correlate well with quadriceps activation, allowing clinicians to use effusion and strength measurement as a surrogate for electrophysiological assessment of quadriceps activation. METHODS Prospective data were collected on 188 patients within 100 days of ACL injury (average, 27 days) referred from a single surgeon. A complete clinical evaluation of the knee was performed, including ligamentous assessment and assessment of range of motion and effusion. Quadriceps function was electrophysiologically assessed using maximal volitional isometric contraction and burst superimposition techniques to quantify both strength and activation. RESULTS Effusion grade did not correlate with quadriceps central activation ratio (CAR) (zero effusion: mean ± SD CAR, 93.5% ± 5.8%; trace effusion: CAR, 93.8% ± 9.5%; 1+ effusion: CAR, 94.0% ± 7.5%; 2+/3+ effusion: CAR, 90.6% ± 11.1%). These values are lower than normative data from healthy subjects (CAR, 98% ± 3%). CONCLUSION Joint effusion after ACL injury does not directly mediate quadriceps activation failure seen after injury. Therefore, it should not be used as a clinical substitute for electrophysiological assessment of quadriceps activation. Patients presenting to physical therapy after ACL injury should be treated with high-intensity neuromuscular electrical stimulation to help normalize this activation. PMID:22523081

LYNCH, ANDREW D.; LOGERSTEDT, DAVID S.; AXE, MICHAEL J.; SNYDER-MACKLER, LYNN

2013-01-01

268

Measurement of in vivo anterior cruciate ligament strain during dynamic jump landing  

PubMed Central

Despite recent attention in the literature, anterior cruciate ligament (ACL) injury mechanisms are controversial and incidence rates remain high. One explanation is limited data on in vivo ACL strain during high-risk, dynamic movements. The objective of this study was to quantify ACL strain during jump landing. Marker-based motion analysis techniques were integrated with fluoroscopic and magnetic resonance (MR) imaging techniques to measure dynamic ACL strain non-invasively. First, eight subjects’ knees were imaged using MR. From these images, the cortical bone and ACL attachment sites of the tibia and femur were outlined to create 3D models. Subjects underwent motion analysis while jump landing using reflective markers placed directly on the skin around the knee. Next, biplanar fluoroscopic images were taken with the markers in place so that the relative positions of each marker to the underlying bone could be quantified. Numerical optimization allowed jumping kinematics to be superimposed on the knee model, thus reproducing the dynamic in vivo joint motion. ACL length, knee flexion, and ground reaction force were measured. During jump landing, average ACL strain peaked 55 ± 14 ms (mean and 95% confidence interval) prior to ground impact, when knee flexion angles were lowest. The peak ACL strain, measured relative to its length during MR imaging, was 12 ± 7%. The observed trends were consistent with previously described neuromuscular patterns. Unrestricted by field of view or low sampling rate, this novel approach provides a means to measure kinematic patterns that elevate ACL strains and that provide new insights into ACL injury mechanisms. PMID:21092960

Taylor, K.A.; Terry, M.E.; Utturkar, G.M.; Spritzer, C.E.; Queen, R.M.; Irribarra, L.A.; Garrett, W.E.; DeFrate, L.E.

2011-01-01

269

Human patellar tendon stiffness is restored following graft harvest for anterior cruciate ligament surgery.  

PubMed

Minimising post-operative donor site morbidity is an important consideration when selecting a graft for surgical reconstruction of the torn anterior cruciate ligament (ACL). One of the most common procedures, the bone-patellar tendon-bone (BPTB) graft involves removal of the central third from the tendon. However, it is unknown whether the mechanical properties of the donor site (patellar tendon) recover. The present study investigated the mechanical properties of the human patellar tendon in 12 males (mean+/-S.D. age: 37+/-14 years) who had undergone surgical reconstruction of the ACL using a BPTB graft between 1 and 10 years before the study (operated knee; OP). The uninjured contralateral knee served as a control (CTRL). Patellar tendon mechanical properties were assessed in vivo combining dynamometry with ultrasound imaging. Patellar tendon stiffness was calculated from the gradient of the tendon's force-elongation curve. Tendon stiffness was normalised to the tendon's dimensions to obtain the tendon's Young's modulus. Cross-sectional area (CSA) of OP patellar tendons was larger by 21% than CTRL tendons (P<0.01). Patellar tendon stiffness was not significantly different between OP and CTRL tendons, but the Young's modulus was lower by 24% in OP tendons (P<0.01). A compensatory enlargement of the patellar tendon CSA, presumably due to scar tissue formation, enabled a recovery of tendon stiffness in the OP tendons. The newly formed tendon tissue had inferior properties as indicated by the reduced tendon Young's modulus, but it increased to a level that enabled recovery of tendon stiffness. PMID:19268289

Reeves, Neil D; Maganaris, Constantinos N; Maffulli, Nicola; Rittweger, Joern

2009-05-11

270

Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking  

PubMed Central

Objectives Prior injury to the knee, particularly anterior cruciate ligament (ACL) injury, is known to predispose one to premature osteoarthritis (OA). The study sought to explore if there was a biomechanical rationale for this process by investigating changes in external knee moments between people with a history of ACL injury and uninjured participants during walking: (1) on different surface inclines and (2) at different speeds. In addition we assessed functional differences between the groups. Participants 12 participants who had undergone ACL reconstruction (ACLR) and 12 volunteers with no history of knee trauma or injury were recruited into this study. Peak knee flexion and adduction moments were assessed during flat (normal and slow speed), uphill and downhill walking using an inclined walkway with an embedded Kistler Force plate, and a ten-camera Vicon motion capture system. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess function. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in gait and KOOS outcomes. Results No significant difference was observed in the peak knee adduction moment between ACLR and control participants, however, in further analysis, MANOVA revealed that ACLR participants with an additional meniscal tear or collateral ligament damage (7 participants) had a significantly higher adduction moment (0.33±0.12?Nm/kg?m) when compared with those with isolated ACLR (5 participants, 0.1±0.057?Nm/kg?m) during gait at their normal speed (p<0.05). A similar (non-significant) trend was seen during slow, uphill and downhill gait. Conclusions Participants with an isolated ACLR had a reduced adductor moment rather an increased moment, thus questioning prior theories on OA development. In contrast, those participants who had sustained associated trauma to other key knee structures were observed to have an increased adduction moment. Additional injury concurrent with an ACL rupture may lead to a higher predisposition to osteoarthritis than isolated ACL deficiency alone. PMID:24898088

Varma, Raghav K; Duffell, Lynsey D; Nathwani, Dinesh; McGregor, Alison H

2014-01-01

271

Isolation and Characterization of Human Anterior Cruciate Ligament-Derived Vascular Stem Cells  

PubMed Central

The anterior cruciate ligament (ACL) usually fails to heal after rupture mainly due to the inability of the cells within the ACL tissue to establish an adequate healing process, making graft reconstruction surgery a necessity. However, some reports have shown that there is a healing potential of ACL with primary suture repair. Although some reports showed the existence of mesenchymal stem cell-like cells in human ACL tissues, their origin still remains unclear. Recently, blood vessels have been reported to represent a rich supply of stem/progenitor cells with a characteristic expression of CD34 and CD146. In this study, we attempted to validate the hypothesis that CD34- and CD146-expressing vascular cells exist in hACL tissues, have a potential for multi-lineage differentiation, and are recruited to the rupture site to participate in the intrinsic healing of injured ACL. Immunohistochemistry and flow cytometry analysis of hACL tissues demonstrated that it contains significantly more CD34 and CD146-positive cells in the ACL ruptured site compared with the noninjured midsubstance. CD34+CD45? cells isolated from ACL ruptured site showed higher expansionary potentials than CD146+CD45? and CD34?CD146?CD45? cells, and displayed higher differentiation potentials into osteogenic, adipogenic, and angiogenic lineages than the other cell populations. Immunohistochemistry of fetal and adult hACL tissues demonstrated a higher number of CD34 and CD146-positive cells in the ACL septum region compared with the midsubstance. In conclusion, our findings suggest that the ACL septum region contains a population of vascular-derived stem cells that may contribute to ligament regeneration and repair at the site of rupture. PMID:21732814

Matsumoto, Tomoyuki; Ingham, Sheila M.; Mifune, Yutaka; Osawa, Aki; Logar, Alison; Usas, Arvydas; Kuroda, Ryosuke; Kurosaka, Masahiro; Fu, Freddie H.

2012-01-01

272

Young women's anterior cruciate ligament injuries: an expanded model and prevention paradigm.  

PubMed

Anterior cruciate ligament (ACL) injuries among young female athletes occur at rates three- to eight-times greater than in male competitors and, in general, females experience more sports injuries than males, when balanced for activity and playing time. ACL injuries are a particular concern, as they result in immediate morbidity, high economic costs and may have long-term adverse effects. While several closely monitored ACL injury preventive programmes have been effective, those efforts have not been uniformly protective nor have they achieved widespread use. To date, ACL injury prevention has focused on neuromuscular and anatomical factors without including issues relating more broadly to the athlete. Coincident with greater female sport participation are other influences that may heighten their injury risk. We review those factors, including early single sport specialization, unhealthy dietary behaviours, chronic sleep deprivation and higher levels of fatigue, substance use and abuse, and psychological issues. We augment existing models of ACL injury with these additional dimensions. The proposed expanded injury model has implications for designing injury prevention programmes. High school athletic teams are natural settings for bonded youth and influential coaches to promote healthy lifestyles, as decisions that result in better athletes also promote healthy lifestyles. As an example of how sport teams could be vehicles to address an expanded injury model, we present an existing evidenced-based sport team-centered health promotion and harm reduction programme for female athletes. Widening the lens on factors influencing ACL injury expands the prevention paradigm to combine existing training with activities to promote psychological well-being and a healthy lifestyle. If developed and shown to be effective, those programmes might better reduce injuries and, in addition, provide life skills that would benefit young female athletes both on and off the playing field. PMID:20433210

Elliot, Diane L; Goldberg, Linn; Kuehl, Kerry S

2010-05-01

273

A tissue engineering approach to anterior cruciate ligament regeneration using novel shaped capillary channel polymer fibers  

NASA Astrophysics Data System (ADS)

Ruptures of the anterior cruciate ligament (ACL) are the most frequent of injuries to the knee due to its role in preventing anterior translation of the tibia. It is estimated that as many as 200,000 Americans per year will suffer from a ruptured ACL, resulting in management costs on the order of 5 billion dollars. Without treatment these patients are unable to return to normal activity, as a consequence of the joint instability found within the ACL deficient knee. Over the last thirty years, a variety of non-degradable, synthetic fibers have been evaluated for their use in ACL reconstruction; however, a widely accepted prosthesis has been unattainable due to differences in mechanical properties of the synthetic graft relative to the native tissue. Tissue engineering is an interdisciplinary field charged with the task of developing therapeutic solutions for tissue and organ failure by enhancing the natural wound healing process through the use of cellular transplants, biomaterials, and the delivery of bioactive molecules. The capillary channel polymer (CC-P) fibers used in this research were fabricated by melt extrusion from polyethylene terephthalate and polybutylene terephthalate. These fibers possess aligned micrometer scale surface channels that may serve as physical templates for tissue growth and regeneration. This inherent surface topography offers a unique and industrially viable approach for cellular contact guidance on three dimensional constructs. In this fundamental research the ability of these fiber channels to support the adhesion, alignment, and organization of fibroblasts was demonstrated and found to be superior to round fiber controls. The results demonstrated greater uniformity of seeding and accelerated formation of multi-layered three-dimensional biomass for the CC-P fibers relative to those with a circular cross-section. Furthermore, the CC-P geometry induced nuclear elongation consistent with that observed in native ACL tissue. Through the application of uniaxial cyclic strain the mechanical properties of the cell seeded CC-P fiber scaffold systems were shown to improve via the induction of increased cellular proliferation and extracellular matrix synthesis. Finally, unlike many studies examining the effects of cyclic strain on cellular behavior, the CC-P fiber geometry displayed the ability to maintain cellular alignment in the presence of an applied uniaxial cyclic strain.

Sinclair, Kristofer D.

274

Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up  

Microsoft Academic Search

The aim of the present investigation was to study patient-reported long-term outcome after anterior cruciate ligament (ACL)\\u000a reconstruction. On an average 11.5 years after ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft 56 patients\\u000a were asked to answer four different questionnaires about their knee function and knee-related quality of life. Another aim\\u000a was to study whether there were any correlations between clinical

Eva Möller; Lars Weidenhielm; Suzanne Werner

2009-01-01

275

Males still have limb asymmetries in multijoint movement tasks more than 2 years following anterior cruciate ligament reconstruction  

Microsoft Academic Search

Background  More than 2 years after undergoing anterior cruciate ligament (ACL) reconstruction, women still present bilateral asymmetries\\u000a during multijoint movement tasks. Given the well-known ACL-injury gender bias, the goal of this study was to investigate whether\\u000a males also present such asymmetries more than 2 years after undergoing ACL reconstruction.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This study involved 12 participants submitted to ACL reconstruction in the ACL group and

Raquel Castanharo; Bruno S. da Luz; Alexandre C. Bitar; Caio O. D’Elia; Wagner Castropil; Marcos Duarte

276

Retrospective Analysis of Arthroscopic Superior Labrum Anterior to Posterior Repair: Prognostic Factors Associated with Failure  

PubMed Central

Background. The purpose of this study was to report on any prognostic factors that had a significant effect on clinical outcomes following arthroscopic Type II SLAP repairs. Methods. Consecutive patients who underwent arthroscopic Type II SLAP repair were retrospectively identified and invited to return for follow-up examination and questionnaire. Statistical analysis was performed to determine associations between potential prognostic factors and failure of SLAP repair as defined by ASES of less than 50 and/or revision surgery. Results. Sixty-two patients with an average age of 36 ± 13 years met the study criteria with a mean followup of 3.3 years. There were statistically significant improvements in mean ASES score, forward elevation, and external rotation among patients. Significant associations were identified between ASES score less than 50 and age greater than 40 years; alcohol/tobacco use; coexisting diabetes; pain in the bicipital groove on examination; positive O'Brien's, Speed's, and/or Yergason's tests; and high levels of lifting required at work. There was a significant improvement in ASES at final followup. Conclusions. Patients younger than 20 and overhead throwers had significant associations with cases requiring revision surgery. The results from this study may be used to assist in patient selection for SLAP surgery. PMID:23585969

Frank, Rachel M.; Nho, Shane J.; McGill, Kevin C.; Grumet, Robert C.; Cole, Brian J.; Verma, Nikhil N.; Romeo, Anthony A.

2013-01-01

277

Effects of tibial slope changes in the stability of fixed bearing medial unicompartmental arthroplasty in anterior cruciate ligament deficient knees.  

PubMed

Patients with anterior cruciate ligament (ACL) deficiency may have increased failure rates with UKA as a result of abnormal contact stresses and altered knee kinematics. Variations in the slope of the tibial component in UKA may alter tibiofemoral translation, and affect outcomes. This cadaveric study evaluated tibiofemoral translation during the Lachman and pivot shift tests after changing the slope of a fixed bearing unicondylar tibial component. Sectioning the ACL increased tibiofemoral translation in both the Lachman and pivot shift tests (P<0.05). Tibial slope leveling (decreasing the posterior slope) of the polyethylene insert in a UKA decreases anteroposterior tibiofemoral translation in the sagittal plane to a magnitude similar to that of the intact knee. With 8° of tibial slope leveling, anterior tibial translation during the Lachman test decreased by approximately 5mm. However, no variation in slope altered the pivot shift kinematics in the ACL deficient knees. PMID:21839639

Suero, Eduardo M; Citak, Musa; Cross, Michael B; Bosscher, Marianne R F; Ranawat, Anil S; Pearle, Andrew D

2012-08-01

278

The long-term biomechanical and viscoelastic performance of repairing anterior cruciate ligament after hemitransection injury in a goat model.  

PubMed

To test the healing of the partially torn anterior cruciate ligament, we transected the posterolateral bundle in 11 adult female goats and tested the ligaments at 12, 24, and 52 weeks and 3 years after surgery. As early as 12 weeks after surgery translucent fibrous tissue covered the wound. The differences in anteroposterior laxity between right and left knees measured at 45 degrees and 90 degrees of flexion were not significantly different at each period. Results of Instron testing of the posterolateral bundle revealed the normalized changes in load-relaxation and Young's modulus were not significantly different at each period, but the ultimate tensile strength and stiffness at 3 years were significantly higher than at 12 weeks (P < 0.05) Failure started at the repair site for the 12-week group, but at 24 and 52 weeks the failure occurred throughout the ligament. At 3 years, the specimens failed with bony avulsion, indicating the repaired tissue was not the weakest link of the bone-ligament-bone complex. This study shows that under favorable conditions, partial anterior cruciate ligament injuries are capable of repair. What is more important, the high ultimate tensile strength and stiffness of the 3-year repaired tissue indicate full structural repair of such an artificial transection injury may be possible. PMID:8638743

Ng, G Y; Oakes, B W; McLean, I D; Deacon, O W; Lampard, D

1996-01-01

279

The effects of levofloxacin on rabbit anterior cruciate ligament cells in vitro  

SciTech Connect

Articular cartilage, epiphyseal growth plate and tendons have been recognized as targets of fluoroquinolone-induced connective tissue toxicity. The effects of fluoroquinolones on ligament tissues are still unknown. The aim of this study was to investigate the effects of levofloxacin, a typical fluoroquinolone antibiotic drug, on rabbit anterior cruciate ligament (ACL) cells in vitro. Rabbit ACL cells were treated with levofloxacin at different concentrations (0, 14, 28, 56, 112 and 224 {mu}M) and were assessed to determine the possible cytotoxic effects of levofloxacin on ACL cells. Levofloxacin, with concentrations ranging from 28 to 224 {mu}M, induced dose-dependent ACL cell apoptosis. Characteristic markers of programmed cell death and degenerative changes were identified by electron microscopy in the ACL cells treated with 28 {mu}M of levofloxacin. Moreover, levofloxacin significantly increased the mRNA expression of matrix metalloproteinase 3 (MMP-3) and MMP-13 and decreased the expression of tissue inhibitors of metalloproteinase 1 (TIMP-1) in a concentration-dependent manner; TIMP-3 and collagen type I alpha 1 (Col1A1) mRNA expression was not affected. Immunocytochemical analysis indicated that levofloxacin markedly increased the expression of active caspase-3 within a concentration range of 28 to 224 {mu}M, whereas a clear-cut decrease in Col1A1 expression was found with levofloxacin treatment concentrations of 112 and 224 {mu}M, compared to controls. Our data suggest that levofloxacin has cytotoxic effects on ACL cells characterized by enhanced apoptosis and decreased extracellular matrix, which suggest a potential adverse effect of fluoroquinolones. -- Highlights: Black-Right-Pointing-Pointer Levofloxacin has cytotoxic effect on rabbit ACL cells in vitro. Black-Right-Pointing-Pointer Levofloxacin induces apoptosis in ACL cells. Black-Right-Pointing-Pointer It decreases extracellular matrix by upregulation of matrix degrading enzymes. Black-Right-Pointing-Pointer ACL cells are more susceptible to cytotoxicity by fluoroquinolones. Black-Right-Pointing-Pointer Our study suggests a potential adverse effect of fluoroquinolones.

Deng, Yu; Chen, Biao; Qi, Yongjian [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)] [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China); Magdalou, Jacques [UMR 7561 CNRS-Nancy Universite, Faculte de Medicine, Vandoeuvre-les-Nancy (France)] [UMR 7561 CNRS-Nancy Universite, Faculte de Medicine, Vandoeuvre-les-Nancy (France); Wang, Hui [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan (China)] [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan (China); Chen, Liaobin, E-mail: lbchen@whu.edu.cn [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)] [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)

2011-11-15

280

Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players  

PubMed Central

Background: Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players. Hypotheses: NBA players undergoing ACL reconstruction (ACLR) have high rates of return to sport (RTS), with RTS the season following surgery, no difference in performance between pre- and postsurgery, and no difference in RTS rate or performance between cases (ACLR) and controls (no ACL tear). Study Design: Case-control. Methods: NBA players undergoing ACLR were evaluated. Matched controls for age, body mass index (BMI), position, and NBA experience were selected during the same years as those undergoing ACLR. RTS and performance were compared between cases and controls. Paired-sample Student t tests, chi-square, and linear regression analyses were performed for comparison of within- and between-group variables. Results: Fifty-eight NBA players underwent ACLR while in the NBA. Mean player age was 25.7 ± 3.5 years. Forty percent of ACL tears occurred in the fourth quarter. Fifty players (86%) RTS in the NBA, and 7 players (12%) RTS in the International Basketball Federation (FIBA) or D-league. Ninety-eight percent of players RTS in the NBA the season following ACLR (11.6 ± 4.1 months from injury). Two players (3.1%) required revision ACLR. Career length following ACLR was 4.3 ± 3.4 years. Performance upon RTS following surgery declined significantly (P < 0.05) regarding games per season; minutes, points, and rebounds per game; and field goal percentage. However, following the index year, controls’ performances declined significantly in games per season; points, rebounds, assists, blocks, and steals per game; and field goal and free throw percentage. Other than games per season, there was no significant difference between cases and controls. Conclusion: There is a high RTS rate in the NBA following ACLR. Nearly all players RTS the season following surgery. Performance significantly declined from preinjury level; however, this was not significantly different from controls. ACL re-tear rate was low. Clinical Relevance: There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls. PMID:24427434

Harris, Joshua D.; Erickson, Brandon J.; Bach, Bernard R.; Abrams, Geoffrey D.; Cvetanovich, Gregory L.; Forsythe, Brian; McCormick, Frank M.; Gupta, Anil K.; Cole, Brian J.

2013-01-01

281

Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction.  

PubMed

Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes. PMID:23041233

Hewett, Timothy E; Di Stasi, Stephanie L; Myer, Gregory D

2013-01-01

282

The natural history of conservatively treated partial anterior cruciate ligament tears  

Microsoft Academic Search

Twenty-five patients with arthroscopically proven par tial ACL tears were reviewed. All patients underwent examination under anesthesia and arthroscopy follow ing an acute injury to a previously normal knee. The percentage of tear was estimated during arthroscopy. Postoperatively, patients were treated with early motion and hamstring strengthening. Weightbearing and quad riceps rehabilitation were delayed. A detailed rating of symptoms and

Steven L. Buckley; Robert L. Barrack; A. Herbert Alexander

1989-01-01

283

Effects of a Platelet Gel on Early Graft Revascularization after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind, Clinical Trial  

Microsoft Academic Search

Background: Slow graft healing in bone tunnels and a slow graft ligamentization process after anterior cruciate ligament (ACL) reconstruction are some of the reasons for prolonged rehabilitation. Aims: The purpose of this study was to determine if the use of platelet gel (PG) accelerates early graft revascularization after ACL reconstruction. Methods: PG was produced from autologous platelet-rich plasma and applied

M. Vogrin; M. Rupreht; D. Dinevski; M. Hašpl; M. Kuhta; M. Jevsek

2010-01-01

284

Anterior Cruciate Ligament—Deficient Potential Copers and Noncopers Reveal Different Isokinetic Quadriceps Strength Profiles in the Early Stage After Injury  

Microsoft Academic Search

Background: Isokinetic muscle strength testing using the peak torque value is the most frequently included quadriceps muscle strength measurement for anterior cruciate ligament (ACL)—injured subjects.Purpose and Hypotheses: The purpose of this study was to investigate quadriceps muscle performance during the whole isokinetic curve in subjects with ACL deficiency classified as potential copers or noncopers and to investigate whether these curve

Ingrid Eitzen; Thomas J. Eitzen; Inger Holm; Lynn Snyder-Mackler; May Arna Risberg

2010-01-01

285

The results of arthroscopic anterior stabilisation of the shoulder using the bioknotless anchor system  

PubMed Central

Background Shoulder instability is a common condition, particularly affecting a young, active population. Open capsulolabral repair is effective in the majority of cases, however arthroscopic techniques, particularly using suture anchors, are being used with increasing success. Methods 15 patients with shoulder instability were operated on by a single surgeon (VK) using BioKnotless anchors (DePuy Mitek, Raynham, MA). The average length of follow-up was 21 months (17 to 31) with none lost to follow-up. Constant scores in both arms, patient satisfaction, activity levels and recurrence of instability was recorded. Results 80% of patients were satisfied with their surgery. 1 patient suffered a further dislocation and another had recurrent symptomatic instability. The average constant score returned to 84% of that measured in the opposite (unaffected) shoulder. There were no specific post-operative complications encountered. Conclusion In terms of recurrence of symptoms, our results show success rates comparable to other methods of shoulder stabilisation. This technique is safe and surgeons familiar with shoulder arthroscopy will not encounter a steep learning curve. Shoulder function at approximately 2 years post repair was good or excellent in the majority of patients and it was observed that patient satisfaction was correlated more with return to usual activities than recurrence of symptoms. PMID:19284697

Cooke, Stephen J; Starks, Ian; Kathuria, Vinod

2009-01-01

286

Serum CTXii Correlates With Articular Cartilage Degeneration After Anterior Cruciate Ligament Transection or Arthrotomy Followed by Standardized Exercise  

PubMed Central

Background: Anterior cruciate ligament injury increases risk for accelerated development of osteoarthritis. The effect of exercise on articular cartilage following joint injury is not well understood. Biochemical biomarkers of collagen degradation and proteoglycan turnover are potential indicators for early articular cartilage degeneration. Hypothesis: This study tests the hypothesis that serum concentrations of CS846 and CTXii correlate with structural changes to articular cartilage following joint injury in exercised animals. Study Design: Controlled laboratory study. Methods: Twenty-four Sprague-Dawley rats underwent either arthrotomy alone (sham surgery) or anterior cruciate ligament transection (ACLT). Animals were recovered for 3 weeks and then exercised on a treadmill at 18 m per minute, 1 hour per day, 5 days per week, until sacrifice either 6 or 12 weeks later. Articular cartilage was assessed grossly, and histology was graded using modified Mankin, toluidine blue, and modified David-Vaudey scales. Serum collected preoperatively and at sacrifice was assayed by ELISA for CTXii and CS846. Results: At 6 weeks, gross grades (P < 0.01), modified Mankin scores (P < 0.03), and toluidine blue scores (P < 0.04) were higher, reflecting increased degeneration in ACLT animals compared with sham surgery animals. Serum CS846 increased after 6 weeks in ACLT animals (P < 0.05). Serum CTXii levels strongly correlated with Mankin degenerative scores (coefficient = 0.81, P < 0.01) and David-Vaudey histology grades (coefficient = 0.73, P < 0.01) at 6 weeks. While gross grades remained higher at 12 weeks in ACLT animals (P < 0.04), no differences were seen in serum CS846 and CTXii. Histology scores also showed no differences between ACLT and sham due to increasing degeneration in the sham surgery group. Conclusion: The strong correlation between serum CTXii and microstructural changes to articular cartilage following joint injury demonstrates potential use of serum biomarkers for early detection of cartilage degeneration. Increasing cartilage degeneration in exercised sham-surgery animals suggests that early loading may have negative effects on articular cartilage due to either mechanical injury or hemarthrosis after arthrotomy. Clinical Relevance: Patients with anterior cruciate ligament injury are at increased risk for development of posttraumatic osteoarthritis. CTXii may be useful for early detection of joint degeneration. Further study on the effects of exercise after injury is important to postinjury and postoperative rehabilitation. PMID:24179591

Coyle, Christian H.; Henry, Sarah E.; Haleem, Amgad M.; O’Malley, Michael J.; Chu, Constance R.

2012-01-01

287

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability  

PubMed Central

Purpose The purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time. Meterials and Methods The study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy. Results There was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture. Conclusion Under MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families. PMID:20376896

Yoon, Yeo Seung; Kwon, Sung Min

2010-01-01

288

Lower Extremity Muscle Strength After Anterior Cruciate Ligament Injury and Reconstruction  

PubMed Central

Context: Quadriceps and hamstrings weakness occurs frequently after anterior cruciate ligament (ACL) injury and reconstruction. Evidence suggests that knee injury may precipitate hip and ankle muscle weakness, but few data support this contention after ACL injury and reconstruction. Objective: To determine if hip, knee, and ankle muscle weakness present after ACL injury and after rehabilitation for ACL reconstruction. Design: Case-control study. Setting: University research laboratory. Patients or Other Participants: Fifteen individuals with ACL injury (8 males, 7 females; age = 20.27 ± 5.38 years, height = 1.75 ± 0.10 m, mass = 74.39 ± 13.26 kg) and 15 control individuals (7 men, 8 women; age = 24.73 ± 3.37 years, height = 1.75 ± 0.09 m, mass = 73.25 ± 13.48 kg). Intervention(s): Bilateral concentric strength was assessed at 60°/s on an isokinetic dynamometer. The participants with ACL injury were tested preoperatively and 6 months postoperatively. Control participants were tested on 1 occasion. Main Outcome Measures: Hip-flexor, -extensor, -abductor, and -adductor; knee-extensor and -flexor; and ankle–plantar-flexor and -dorsiflexor strength (Nm/kg). Results: The ACL-injured participants demonstrated greater hip-extensor (percentage difference = 19.7, F1,14 = 7.28, P = .02) and -adductor (percentage difference = 16.3, F1,14 = 6.15, P = .03) weakness preoperatively than postoperatively, regardless of limb, and greater postoperative hip-adductor strength (percentage difference = 29.0, F1,28 = 10.66, P = .003) than control participants. Knee-extensor and -flexor strength were lower in the injured than in the uninjured limb preoperatively and postoperatively (extensor percentage difference = 34.6 preoperatively and 32.6 postoperatively, t14 range = ?4.59 to ?4.23, P ? .001; flexor percentage difference = 30.6 preoperatively and 10.6 postoperatively, t14 range = ?6.05 to ?3.24, P < .05) with greater knee-flexor (percentage difference = 25.3, t14 = ?4.65, P < .001) weakness preoperatively in the injured limb of ACL-injured participants. The ACL-injured participants had less injured limb knee-extensor (percentage difference = 32.0, t28 = ?2.84, P = .008) and -flexor (percentage difference = 24.0, t28 = ?2.44, P = .02) strength preoperatively but not postoperatively (extensor: t28 = ?1.79, P = .08; flexor: t28 = 0.57, P = .58) than control participants. Ankle–plantar-flexor weakness was greater preoperatively than postoperatively in the ACL-injured limb (percentage difference = 31.9, t14 = ?3.20, P = .006). Conclusions: The ACL-injured participants presented with hip-extensor, -adductor, and ankle–plantar-flexor weakness that appeared to be countered during postoperative rehabilitation. Our results confirmed previous findings suggesting greater knee-extensor and -flexor weakness postoperatively in the injured limb than the uninjured limb. The knee extensors and flexors are important dynamic stabilizers; weakness in these muscles could impair knee joint stability. Improving rehabilitation strategies to better target this lingering weakness seems imperative. PMID:24067150

Thomas, Abbey C.; Villwock, Mark; Wojtys, Edward M.; Palmieri-Smith, Riann M.

2013-01-01

289

Potential utility of cell sheets derived from the anterior cruciate ligament and synovium fabricated in temperature-responsive culture dishes.  

PubMed

Development of tissue-engineered materials to treat anterior cruciate ligament (ACL) injury has been limited by the lack of phenotypic markers. We investigated the feasibility of inducing ACL regeneration using cell sheet technology based on the expression of tenomodulin (TNMD) as an early phenotypic marker of ligaments. ACL remnants, the synovium surrounding cruciate ligaments (SCL), the synovium surrounding the infrapatellar fat pads (SIF), and subcutaneous fat tissue (SCF) were obtained from patients undergoing ACL reconstruction or total knee arthroplasty. ACL cell sheets and SCL-derived cell sheets were fabricated successfully A three-dimensional bioengineered ACL was generated by combining triple-layered ACL cell sheets with a bioabsorbable mesh composite. Immunohistochemical examination showed that TNMD was expressed in human ACL fibers, triple-layered ACL cell sheets, ACL remnants, SCL, and SIF, but not in SCF. Real-time PCR showed that TNMD mRNA was expressed at substantially higher levels in the ACL, SCL, and SIF than in the SCF. These results suggest that TNMD is a specific marker of the human ACL and that ACL sheets have a phenotype similar to that of the ACL. The greater expression of TNMD in the SCL- and SIF- suggests that the synovium is a potential cell source for ACL regeneration. PMID:24089357

Mitani, Genya; Sato, Masato; Yamato, Masayuki; Kokubo, Mami; Takagaki, Tomonori; Ebihara, Goro; Okano, Teruo; Mochida, Joji

2014-09-01

290

Physeal-sparing technique for femoral tunnel drilling in pediatric anterior cruciate ligament reconstruction using a posteromedial portal.  

PubMed

Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

Lemos, Stephen E; Keating, Patrick M; Scott, Timothy P; Siwiec, Ryan M

2013-11-01

291

Tibia Rotational Technique to Drill Femoral Bone Tunnel in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

In anatomic anterior cruciate ligament (ACL) reconstruction, several pitfalls in creating the femoral bone tunnels at the correct position are of great concern. Our new method, the tibia rotational (TR) technique, may contribute to resolving these. The purpose of this study is to describe further details about the TR technique in anatomic double-bundle ACL reconstruction. Both anteromedial and posterolateral femoral bone tunnels were drilled through a posterolateral tibial bone tunnel using tibial rotation without deep knee flexion. When it is difficult to reach the mark with the rigid guide pin, the narrow curved TR technique guide and the flexible drill system allow drilling femoral bone tunnels in the correct position. The TR technique offers the technical ease required for widespread acceptance while prioritizing the fundamental goals of an anatomic double-bundle ACL reconstruction.

Mitani, Genya; Takagaki, Tomonori; Hamahashi, Kosuke; Kaneshiro, Nagatoshi; Serigano, Kenji; Maeda, Takashi; Nakamura, Yutaka; Mochida, Joji

2014-01-01

292

Effects of Closed Kinetic Chain Exercises on Proprioception and Functional Scores of the Knee after Anterior Cruciate Ligament Reconstruction  

PubMed Central

[Purpose] The purpose of this study was to examine the effect of closed kinetic chain exercises performed by an unstable exercise group (UEG) and a stable exercise group (SEG) on the knee joint, proprioception, and functional scores of patients who underwent anterior cruciate ligament (ACL) reconstruction. [Subjects] Twenty-eight patients participated in this study. The exclusion criteria were fracture or neurological disease. [Methods] The subjects were randomly assigned to one of two groups, each with 14 people. Each group took part in a 60-minute exercise program, three times a week for six weeks. [Results] The results of the clinical evaluation at 45°proprioception showed statistically significant differences between the two groups. The results of the clinical evaluation at 15°proprioception showed no statistically significant differences between the two groups. [Conclusion] The proprioception and functional scores of the patients in the UEG who underwent ACL reconstruction were superior to those in the SEG group. PMID:24259766

Cho, Sung-Hyoun; Bae, Chang-Hwan; Gak, Hwang-Bo

2013-01-01

293

Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.  

PubMed

Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented. PMID:24949986

Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

2014-10-01

294

Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal  

PubMed Central

Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

2013-01-01

295

Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes.  

PubMed

We report on 22 patients with chronic grade-2 valgus laxity of the knee combined with chronic anterior cruciate ligament (ACL) insufficiency, in whom the two lesions were addressed at the same surgical setting. At a minimum follow-up of 24 months, clinical and functional variables had improved significantly (P < 0.001), and 20 of the 22 patients (91%) had returned to sport at pre-injury level. There were no operative complications in this series. In selected athletes with chronic symptomatic valgus laxity of the knee combined with ACL insufficiency, surgical repair of the MCL in association with ACL reconstruction is a suitable and reliable option to restore knee stability and allow return to pre-injury activity level. PMID:19838671

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Merlo, Franco; Denaro, Vincenzo; Maffulli, Nicola

2010-03-01

296

Evaluation of isokinetic and isometric strength measures for monitoring muscle function recovery after anterior cruciate ligament reconstruction.  

PubMed

Although various strength tests and their outcome measures have been proposed for anterior cruciate ligament (ACL) reconstruction (ACLR), their measurement properties still remain relatively underexplored. The aim of this study was to investigate the longitudinal construct validity of the standard isokinetic (IKT) and isometric test (IMT), and of the IMT of alternating consecutive maximal contractions (ACMC). In addition, the concurrent validity of ACMC was assessed and compared with the validity of IMT. The strength of quadriceps and hamstrings in 20 male athletes with an anterior cruciate ligament (ACL) injury were assessed before ACLR, 4 and 6 months after ACLR, by means of IMT, ACMC, and IKT performed at 60 and 180° · s(-1). Significant between-session differences in muscle strength variables were found in the involved quadriceps (F > 6.5; p ? 0.05), but not in the uninvolved leg (F < 2.5; p > 0.05). Coefficients of variations in the uninvolved leg (all below 13.5%) were lower than the involved leg (11.7-22.1%). Intraclass correlation coefficients were moderate-to-high for the uninvolved leg and low-to-high for quadriceps of the involved leg. The concurrent validity of ACMC with respect to the IKT (r = 0.57-0.92; p ? 0.05) was comparable with the validity of IMT (r = 0.52-0.87; p ? 0.05). We conclude that the explored longitudinal construct validity of most of the evaluated variables could be sufficiently sensitive to detect the effects of the applied rehabilitation procedures. In addition, the obtained sensitivity and concurrent validity and the potential advantages of ACMC over IMT, all suggest that ACMC could be a particularly promising method for routine testing of neuromuscular function after ACLR. PMID:24169472

Knezevic, Olivera M; Mirkov, Dragan M; Kadija, Marko; Milovanovic, Darko; Jaric, Slobodan

2014-06-01

297

A technique for arthroscopic fasciotomy for the chronic exertional tibialis anterior compartment syndrome  

Microsoft Academic Search

Chronic exertional anterior compartment syndrome (CECS) is a condition that causes pain over the front of the shin bone that\\u000a usually occurs in physically active people, especially runners. It may require sometimes an immediate fasciotomy. A longitudinal\\u000a incision just over the fibula has used as surgical treatment bad cosmetic appearance. Although nowadays mini surgical incisions\\u000a are preferred. The aim of

Ahmet Sebik; Ali Do?an

2008-01-01

298

Assessment of standing balance deficits in people who have undergone anterior cruciate ligament reconstruction using traditional and modern analysis methods.  

PubMed

Modern methods of assessing standing balance such as wavelet and entropy analysis could provide insight into postural control mechanisms in clinical populations. The aim of this study was to examine what effect anterior cruciate ligament reconstruction (ACLR) has on traditional and modern measures of balance. Ninety subjects, 45 who had undergone ACLR and 45 matched controls, performed single leg static standing balance tests on their surgical or matched limb on a Nintendo Wii Balance Board. Data were analysed in the anterior-posterior axis of movement, which is known to be affected by ACLR. The traditional measures of path velocity, amplitude and standard deviation were calculated in this plane. Additionally, sample entropy and discrete wavelet transform derived assessment of path velocity in four distinct frequency bands related to (1) spinal reflexive loops and muscle activity, (2) cerebellar, (3) vestibular, and (4) visual mechanisms of postural control were derived. The ACLR group had significantly increased values in all traditional measures and all four frequency bands. No significant difference was observed for sample entropy. This indicated that whilst postural sway was amplified in the ACLR group, the overall mechanism used by the patient group to maintain balance was similar to that of the control group. In conclusion, modern methods of signal analysis may provide additional insight into standing balance mechanisms in clinical populations. Future research is required to determine if these results provide important and unique information which is of benefit to clinicians. PMID:24433669

Clark, Ross A; Howells, Brooke; Pua, Yong-Hao; Feller, Julian; Whitehead, Tim; Webster, Kate E

2014-03-21

299

Functional outcomes and health-related quality of life after robot-assisted anterior cruciate ligament reconstruction with patellar tendon grafts  

Microsoft Academic Search

During a short period of time, surgical robots had been propagated for automated tunnel placement in anterior cruciate ligament\\u000a (ACL) reconstruction. Clinical outcome data are currently unavailable. Between 2000 and 2003, 152 patients underwent ACL replacement\\u000a with the assistance of the Computer Assisted Surgical Planning and Robotics system (CASPAR, OrtoMaquet, Germany) at our hospital.\\u000a After minimal invasive pin placement in

Dirk Stengel; Frank Klufmöller; Grit Rademacher; Sven Mutze; Kai Bauwens; Kay Butenschön; Julia Seifert; Michael Wich; Axel Ekkernkamp

2009-01-01

300

Correlation Between Knee Laxity and Graft Appearance on Magnetic Resonance Imaging After Double-Bundle Hamstring Graft Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: In recent years, double-bundle (anteromedial bundle [AMB], posterolateral bundle [PLB]) anterior cruciate ligament reconstruction has developed into an accepted practical surgical procedure; therefore, its efficacy needs to be established.Hypothesis: Multiple-sliced 2-dimensional magnetic resonance imaging allows evaluation of each bundle separately. Both bundles are important for knee stability, and each bundle has a role in the prevention of knee instability.

Masaki Sonoda; Tsuguo Morikawa; Kan Tsuchiya; Hideshige Moriya

2007-01-01

301

The reliability of a method for measuring the anterior cruciate ligament-hamstring reflex: an objective assessment of functional knee instability  

Microsoft Academic Search

Anterior cruciate ligament (ACL) rupture leads to mechanical and functional knee instability. Functional instability is likely\\u000a attributable to a sensorimotor deficit. In previous studies, a method has been introduced which allows this deficit to be\\u000a objectively assessed using ACL-hamstring reflex measurements. There is evidence that subjectively stable and unstable patients\\u000a with ACL rupture can be objectively distinguished by this method.

Markus Schoene; Christoph Spengler; Baerbel Fahrbacher; Julia Hartmann; Marc Melnyk; Benedikt Friemert

2009-01-01

302

New insights into anterior cruciate ligament deficiency and reconstruction through the assessment of knee kinematic variability in terms of nonlinear dynamics  

Microsoft Academic Search

Purpose  Injuries to the anterior cruciate ligament (ACL) occur frequently, particularly in young adult athletes, and represent the\\u000a majority of the lesions of knee ligaments. Recent investigations suggest that the assessment of kinematic variability using\\u000a measures of nonlinear dynamics can provide with important insights with respect to physiological and pathological states.\\u000a The purpose of the present article was to critically review

Leslie M. Decker; Constantina Moraiti; Nicholas Stergiou; Anastasios D. Georgoulis

303

Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts  

Microsoft Academic Search

Existing clinical studies have not proven which graft is to be preferred in anterior cruciate ligament (ACL) reconstruction.\\u000a In recent years, bone-patellar tendon-bone and hamstring tendons have been the most frequently used graft types. Muscle strength\\u000a deficit is one of the consequences after ACL reconstruction. The aim of this study was to evaluate possible differences in\\u000a hamstring and quadriceps muscle

Riitta Lautamies; Arsi Harilainen; Jyrki Kettunen; Jerker Sandelin; Urho M. Kujala

2008-01-01

304

A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system  

Microsoft Academic Search

We conducted a prospective randomised study of anatomical single-bundle (A-SB group) versus double-bundle (A-DB group) anterior\\u000a cruciate ligament (ACL) reconstruction using the hamstrings tendons. Twenty patients with unilateral ACL deficiency were randomised\\u000a into two groups. We created the bone tunnels at the position of the original insertion of the anteromedial bundle footprint\\u000a and posterolateral bundle footprint in the A-DB group

Daisuke Araki; Ryosuke Kuroda; Seiji Kubo; Norifumi Fujita; Katsumasa Tei; Koji Nishimoto; Yuichi Hoshino; Takehiko Matsushita; Tomoyuki Matsumoto; Koki Nagamune; Masahiro Kurosaka

2011-01-01

305

Biomechanical evaluation of patellar and hamstring tendon graft fixation for anterior cruciat ligament reconstruction using a poly-(D, L-lactide) interference screw  

Microsoft Academic Search

Summary  \\u000a Anterior cruciate ligament (ACL) reconstruction using autologous hamstring tendons are being performed more frequently and\\u000a satisfactory results have been reported. Advantages such as low donor site morbidity and ease of harvest as well as disadvantages\\u000a like low initial construct stiffness have been described. Recently, it has been demonstrated that graft fixation close to\\u000a the original ACL insertion sites increases

A. Weiler; R. F. G. Hoffmann; N. P. Südkamp; C. J. Siepe; N. P. Haas

1999-01-01

306

The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective  

Microsoft Academic Search

Football (soccer), the most popular sport worldwide, is associated with a high injury risk, and the knee joint is often affected.\\u000a Several studies have found female players to be more susceptible to knee injury, anterior cruciate ligament (ACL) injury in\\u000a particular, compared to their male counterparts. There is, however, some controversy regarding the magnitude of this risk\\u000a increase and a

Markus Waldén; Martin Hägglund; Jonas Werner; Jan Ekstrand

2011-01-01

307

Measurement of the graft angles for the anterior cruciate ligament reconstruction with transtibial technique using postoperative magnetic resonance imaging in comparative study  

Microsoft Academic Search

The aims of this study were to quantify the angle and placement of an anterior cruciate ligament (ACL) grafted with a single\\u000a incision ACL reconstruction technique using postoperative magnetic resonance imaging (MRI), and to compare the results with\\u000a those with a native ACL. Between February 1996 and May 2004, 96 consecutive patients, who had undergone postoperative MRI\\u000a of the knee

Jin Hwan Ahn; Sang Hak Lee; Jae Chul Yoo; Hae Chan Ha

2007-01-01

308

Two to 4Year Follow-up to a Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: There have been no long-term follow-up studies comparing a predominantly home-based rehabilitation program with a standard physical therapy program after anterior cruciate ligament (ACL) reconstruction. Demonstrating the long-term success of such a cost-effective program would be beneficial to guide future rehabilitation practice.Purpose: To determine whether there were any differences in long-term outcome between recreational athletes who performed a physical

John A. Grant; Nicholas G. H. Mohtadi

2010-01-01

309

A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes  

Microsoft Academic Search

Female athletes are more prone to anterior cruciate ligament (ACL) injury than their male counterparts, presumably because\\u000a of anatomical, hormonal, and neuromuscular differences. Of these three, only the neuromuscular component can be modified by\\u000a preventive exercise. We aimed to evaluate the effect of a neuromuscular protocol on the prevention of ACL injury by performing\\u000a meta-analysis, and to identify essential factors

Jae Ho Yoo; Bee Oh Lim; Mina Ha; Soo Won Lee; Soo Jin Oh; Yong Seuk Lee; Jin Goo Kim

2010-01-01

310

Effect of Anterior Cruciate Ligament Reconstruction and Meniscectomy on Length of Career in National Football League AthletesA Case Control Study  

Microsoft Academic Search

Background: Meniscal and anterior cruciate ligament (ACL) injuries are common in college football athletes. The effect of meniscectomy and\\/or ACL surgery on the length of an athlete’s career in the National Football League (NFL) has not been well examined.Hypothesis: Athletes with a history of meniscectomy or ACL surgery before the NFL combine have a shorter career than matched controls.Study Design:

Robert H. Brophy; Corey S. Gill; Stephen Lyman; Ronnie P. Barnes; Scott A. Rodeo; Russell F. Warren

2009-01-01

311

Anterior cruciate ligament reconstruction using autologous hamstring single-bundle Rigidfix technique compared with single-bundle Transfix technique  

PubMed Central

Background: Initial fixation strength is critical for the early post-operative rehabilitation of patients with anterior cruciate ligament (ACL) reconstructions. However, even the best femoral fixation devices remain controversial. We compared the results of 2 of the femoral fixation techniques,Rigidfix and Transfix. Materials and Methods: A total of 30 patients with unilateral ACL deficiency were randomly assigned to 1 of 2 groups. In Group A an anatomic single-bundle ACL reconstruction was performed using Rigidfix technique(Mitek, Norwood,MA), Group B were treated by a single bundle using Transfix technique(Arthrex, Naples, FL, USA). For tibial fixation, a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. The patients were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman's and the pivot-shift tests. They also completed the International Knee Documentation Committee (IKDC) score. Results: At a mean of 14 months (12–17) followup there were no significant differences concerning time between injury and range of movement between the 2 groups. However, the Rigidfix group showed significantly better results for the subjective assessment of knee function (P = 0.002). The Lachman, anterior drawer, and pivot-shift tests also showed no significant difference between the 2 groups. The IKDC scale showed no significant difference among the groups (P < 0.001).There was no difference regarding duration of operation and cost of the operation between the 2 groups.On clinical evaluation there was no significant difference between the 2 groups. However, regardless of the technique, all knees were improved by ACL reconstruction compared with their preoperative status. Conclusion: Both techniques can be used for reconstruction of ACL. Other factors, such as psychic profile of the patients should be considered for surgery planning. PMID:23210091

Hamid, Mousavi; Majid, Mohammadi

2012-01-01

312

Long-term effects of knitted silk-collagen sponge scaffold on anterior cruciate ligament reconstruction and osteoarthritis prevention.  

PubMed

Anterior cruciate ligament (ACL) is difficult to heal after injury due to the dynamic fluid environment of joint. Previously, we have achieved satisfactory regeneration of subcutaneous tendon/ligament with knitted silk-collagen sponge scaffold due to its specific "internal-space-preservation" property. This study aims to investigate the long-term effects of knitted silk-collagen sponge scaffold on ACL regeneration and osteoarthritis prevention. The knitted silk-collagen sponge scaffold was fabricated and implanted into a rabbit ACL injury model. The knitted silk-collagen sponge scaffold was found to enhance migration and adhesion of spindle-shaped cells into the scaffold at 2 months post-surgery. After 6 months, ACL treated with the knitted silk-collagen sponge scaffold exhibited increased expression of ligament genes and better microstructural morphology. After 18 months, the knitted silk-collagen sponge scaffold-treated group had more mature ligament structure and direct ligament-to-bone healing. Implanted knitted silk-collagen sponge scaffolds degraded much more slowly compared to subcutaneous implantation. Furthermore, the knitted silk-collagen sponge scaffold effectively protected joint surface cartilage and preserved joint space for up to 18 months post-surgery. These findings thus demonstrated that the knitted silk-collagen sponge scaffold can regenerate functional ACL and prevent osteoarthritis in the long-term, suggesting its clinical use as a functional bioscaffold for ACL reconstruction. PMID:24974007

Shen, Weiliang; Chen, Xiao; Hu, Yejun; Yin, Zi; Zhu, Ting; Hu, Jiajie; Chen, Jialin; Zheng, Zefeng; Zhang, Wei; Ran, Jisheng; Heng, Boon Chin; Ji, Junfeng; Chen, Weishan; Ouyang, Hong-Wei

2014-09-01

313

Comparison of hamstring muscle behavior for anterior cruciate ligament (ACL) patient and normal subject during local marching  

NASA Astrophysics Data System (ADS)

This study aims to investigate the hamstring muscle activity after the surgery by carrying out an electromyography experiment on the hamstring and to compare the behavior of the ACL muscle activity between ACL patient and control subject. Electromyography (EMG) is used to study the behavior of muscles during walking activity. Two hamstring muscles involved which are semitendinosus and bicep femoris. The EMG data for both muscles were recorded while the subject did maximum voluntary contraction (MVC) and marching. The study concluded that there were similarities between bicep femoris of the ACL and control subjects. The analysis showed that the biceps femoris muscle of the ACL subject had no abnormality and the pattern is as normal as the control subject. However, ACL patient has poor semitendinosus muscle strength compared to that of control subject because the differences of the forces produced. The force of semitendinosus value for control subject was two times greater than that of the ACL subject as the right semitendinosus muscle of ACL subject was used to replace the anterior cruciate ligament (ACL) that was injured.

Amineldin@Aminudin, Nurul Izzaty Bt.; Rambely, A. S.

2014-09-01

314

Relationship between quadriceps femoris muscle volume and muscle torque at least 18 months after anterior cruciate ligament reconstruction.  

PubMed

The purpose of this study was to evaluate motor unit recruitment in the quadriceps femoris (QF) after anterior cruciate ligament (ACL) rupture and repair. Subjects included 24 patients at ? 18 months after ACL reconstruction and 22 control subjects with no history of knee injury. A series of cross-sectional magnetic resonance images were obtained to compare the QF of patients' injured side with that of their uninjured sides and that of uninjured control subjects. Muscle torque per muscle volume was calculated as isokinetic peak torque divided by QF muscle volume (cm(3)). The mean muscle torque per unit volume of the injured side of patients was not significantly different from that of the uninjured side or control subjects (one-way ANOVA) Results of the present study were contrary to the results of a previous study that evaluated patients at ? 12 months after ACL reconstruction. The present study found that high-threshold motor unit recruitment was restored at ? 18 months after ACL reconstruction. Thus, clinicians must develop techniques that increase the recruitment of high-threshold motor units in the QF from the period immediately after the injury until approximately 18 months after ACL reconstruction. PMID:21599756

Konishi, Y; Oda, T; Tsukazaki, S; Kinugasa, R; Fukubayashi, T

2012-12-01

315

Design and Evaluation of Surgical Navigation for Anterior Cruciate Ligament Reconstruction using Autostereoscopic Image Overlay of Integral Videography.  

PubMed

This paper describes a surgical navigation system for anterior cruciate ligament (ACL) reconstruction using an autostereoscopic image overlay technique. We superimpose a real three-dimensional (3-D) image onto the patient for image-guided therapy. The images are created by employing an animated visualization of integral videography (IV). IV records and reproduces 3-D images using a micro convex lens array and flat display; it can display geometrically accurate 3-D autostereoscopic images and reproduce motion parallax without the need for any special viewing or tracking devices. The use of semi-transparent display devices makes it appear that the 3-D image is inside the patient's body, which enables viewing the structure of ACL and detecting the position of femur, tibia and surgical tools. This is the first report of applying an autostereoscopic display with an image overlay system in ACL reconstruction surgery. Experiments demonstrated that the patient-image registration method and the fast IV rendering technique produce an average registration accuracy of 1.16 mm and frame rate of IV image display about 3 frames and 11 frames per second for organ and surgical tools respectively. PMID:17282917

Liao, Hongen; Matsui, Kazuhiro; Dohi, Takeyoshi

2005-01-01

316

The Kinematic Control During the Backward Gait and Knee Proprioception: Insights from Lesions of the Anterior Cruciate Ligament  

PubMed Central

An already existing large volume of work on kinematics documents a reduction of step length during unusual gaits, such as backward walking. This is mainly explained in terms of modifications of some biomechanical properties. In the present study, we propose that the proprioceptive information from the knee may be involved in this change of motor strategy. Specifically, we show that a non-automated condition such as backward walking can elicit different motor strategies in subjects with reduced proprioceptive feedback after anterior cruciate ligament lesion (ACL). For this purpose, the kinematic parameters during forward and backward walking in subjects with ACL deficit were compared to two control groups: a group with intact ACL and a group with surgically reconstructed ACL. The knee proprioception was tested measuring the threshold for detection of passive knee motion. Subjects were asked to walk on a level treadmill at five different velocities (1–5km/h) in forward and backward direction, thereby calculating the cadence and step length. Results showed that forward walking parameters were largely unaffected in subjects with ACL damage. However, they failed to reduce step length during backward walking, a correction that was normally observed in all control subjects and in subjects with normal proprioceptive feedback after ACL reconstruction. The main result of the present study is that knee proprioception is an important signal used by the brain to reduce step length during the backward gait. This can have a significant impact on clinical evaluation and rehabilitation. PMID:25114731

Viggiano, Davide; Corona, Katia; Cerciello, Simone; Vasso, Michele; Schiavone-Panni, Alfredo

2014-01-01

317

Chiropractic management of a postoperative complete anterior cruciate ligament rupture using a multimodal approach: a case report  

PubMed Central

Objective The purpose of this case report is to describe the chiropractic management of a patient who had postoperative reconstructive surgery for an anterior cruciate ligament (ACL) tear. Clinical Features A 25-year-old man experienced a rupture of his left ACL, as well as a bucket-handle tear of the medial meniscus and full-thickness tear within the posterior horn of the lateral meniscus, following direct-contact trauma while playing basketball. Intervention and Outcome Postoperative care included a 12-week functional chiropractic rehabilitation program along with Active Release Technique, Graston Technique, and Kinesio Taping. Following treatment, the patient recorded a 0/10 on the Numeric Pain Scale, recorded improvement on the Patient Specific Functional and Pain Scales, returned to play with no complications, and had complete restoration of range of motion and lower extremity muscle strength. At 1-year follow-up, the patient reported no pain and was fully functional. Conclusion A multimodal approach to the treatment of a postsurgical ACL repair was successful in restoring functional ability, as well as complete subjective pain relief. Chiropractic care may be a beneficial addition to the care of postoperative patients. PMID:22027208

Solecki, Thomas J.; Herbst, Elizabeth M.

2011-01-01

318

Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction?  

PubMed

The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique. PMID:23438253

Signorelli, C; Bonanzinga, T; Lopomo, N; Marcheggiani Muccioli, G M; Bignozzi, S; Filardo, G; Zaffagnini, S; Marcacci, M

2013-08-01

319

All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Surgical Technique Using a Split Tibial Tunnel  

PubMed Central

Many techniques have been described for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, including extra-articular, complete or partial transphyseal, and physeal-sparing techniques. An all-epiphyseal technique places the tendon and its tunnels and fixation all within the child's epiphysis, leaving the growth plates untouched. We describe an all-epiphyseal quadruple-hamstring ACL reconstruction using a split tibial tunnel. The split tibial tunnels drop the tunnel size down to 4.5 to 5.5 mm from 7 to 8 mm because only half the total graft diameter passes through each of the split tunnels. This increases the safety margin for keeping the tunnel within the tibial epiphysis, in addition to avoiding damage into the growth plate. The bone bridge between the 2 tunnels serves as a solid low-profile fixation post. Femoral graft fixation is achieved with an interference screw, which allows precise tensioning and low-profile fixation entirely within the femoral tunnel. By placing the graft at the native ACL's anatomic attachment points without spanning or violating the growth plates at any step of the procedure, an all-epiphyseal ACL reconstruction with a split tibial tunnel theoretically minimizes the risk of growth disturbance in an ACL-deficient child. PMID:23766968

Lykissas, Marios G.; Nathan, Senthil T.; Wall, Eric J.

2012-01-01

320

A systematic literature review to investigate if we identify those patients who can cope with anterior cruciate ligament deficiency.  

PubMed

Rupture of the anterior cruciate ligament (ACL) results in increased tibiofemoral laxity in the knee, thereby ultimately resulting in knee instability and dysfunction. However, ACL rupture does not automatically infer functional impairment and instability as confirmed by the ACL deficient (ACLD) coper, who can resume pre-morbid activity levels. Alternatively, an authentic ACLD non-coper is unable to return to pre-injury levels of activity due to repeated incidents of giving-way. Little is known as to the contributory factors, which allows copers dynamic stability and render non-copers functionally impaired. This systematic literature review aims to examine the evidence presented by relevant trials in order to identify measurement tools, which could differentiate ACLD copers and non-copers. A literature search found nine trials; four adhered to the inclusion criteria of this review. Consensus was achieved within the studies that laxity measurements and IKDC ratings are incapable of distinguishing the functional status of the ACLD patient. Alternatively, Lysholm, KOS-Sport, KOS-ADL and Global Knee Function Rating Scores were regarded as capable of discriminating between ACLD copers and non-copers. Disagreement existed as to the efficacy of the Quadriceps Index and the single leg hop in categorising the ACLD patient according to function level. It was concluded that no single measurement tool is sufficient in determining the functional status of the ACLD individual. Consequently, a collaboration of tests is recommended, specifically incorporating the KOS-Sport, Global Knee Function Rating, hop tests and Quadriceps Index. PMID:16806942

Herrington, Lee; Fowler, Elizabeth

2006-08-01

321

Factors affecting outcome after anterior cruciate ligament injury: a prospective study with a six-year follow-up.  

PubMed

The aim of this study was to investigate whether gender, age, stable personality traits, associated meniscus and/or articular cartilage injuries, treatment (non-operative or reconstructive surgery), additional subsequent trauma to the anterior cruciate ligament (ACL)-injured knee and activity level before injury affect the intermediate outcome after ACL injury. The primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS). Fifty-seven patients, 18-50 years old with an acute, unilateral ACL tear were included in the study. At the time of inclusion, the patients completed the Tegner score, regarding activity level before injury, and Swedish universities Scales of Personality (SSP). At follow-up, after 5.6 years they completed the KOOS, the Tegner score and a general questionnaire concerning ACL reconstruction and subsequent knee trauma. The subjects who had sustained additional trauma subsequent to their ACL injury had a significantly worse outcome according to the KOOS than those who had not. Furthermore, low ratings in the embitterment scale in the SSP were correlated to a better outcome in the KOOS. Treatment did not affect the KOOS total score. However, the non-operatively treated subjects had a significantly better outcome according to the knee-related quality-of-life domain in the KOOS. PMID:18067527

Swirtun, L R; Renström, P

2008-06-01

322

Cross Pins versus Endobutton Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction: Minimum 4-Year Follow-Up  

PubMed Central

Purpose We aimed to compare cross-pin fixation and Endobutton femoral fixation for hamstring anterior cruciate ligament (ACL) reconstruction with respect to clinical and radiographic results, including tunnel widening and the progression of knee osteoarthritis (OA). Materials and Methods Between August 2002 and August 2005, 126 autogenous hamstring ACL reconstructions were performed using either cross pins or Endobutton for femoral fixation. Fifty-six of 75 patients in the cross-pin group and 35 of 51 patients in the Endobutton group were followed up for a minimum of 4 years. We compared the clinical and radiological results between the groups using the International Knee Documentation Committee (IKDC) evaluation form, the KT-2000 arthrometer side to side difference, the amount of tunnel widening and the advancement of OA on radiographs. Results There were no significant differences in the IKDC grades between the groups at the 4 year follow-up. There was no significant difference in the side to side difference according to KT-2000 arthrometer testing. Also, there were no significant differences in terms of tunnel widening or advancement of OA on radiographs. Conclusions Endobutton femoral fixation showed good results that were comparable to those of cross pins fixation in hamstring ACL reconstruction. PMID:22570850

Kong, Chae-Gwan; Kim, Geon-Hyeong; Ahn, Chi-Young

2012-01-01

323

Assessment of functional impairment after knee anterior cruciate ligament reconstruction using cardiorespiratory parameters: a cross-sectional study  

PubMed Central

Background A dynamic sub-maximum exercise with the same absolute intensity, performed with different muscle groups, may present exacerbated cardiorespiratory responses. Therefore, cardiorespiratory responses to unilateral exercise may identify bilateral differences. The purpose of this study was to verify whether the cardiorespiratory responses to lower limb exercise display counter-lateral differences, and if they could be used to assist athletes and health professionals involved in rehabilitation. Methods Nine individuals participated in this cross-sectional study. They had been treated in a private rehabilitation clinic and submitted to intra-articular reconstruction of the anterior cruciate ligament. The cycling exercise with the same sub-maximal intensity and with one lower limb was used to gather data. Cardiorespiratory responses to exercise were compared between exercises performed with the involved and uninvolved limb after five minutes of exercise. Results Cardiorespiratory responses to exercise performed with the involved limb presented higher values after five minutes of cycling: oxygen uptake (+7%), carbon dioxide production (+10%), minute ventilation (+20%), breathing frequency (+19%), ventilatory equivalent for oxygen (+14%), end-tidal pressure of O2 oxygen (+4%), end-tidal pressure of O2 carbon dioxide (-9%) and heart rate (+9%). Conclusions The exacerbated responses, including increase of the ventilatory equivalent and decrease of end-tidal pressure of carbon dioxide, indicate that this exercise protocol may be useful in the characterization of the functional deficit of the surgical limb during rehabilitation. PMID:24885115

2014-01-01

324

Immature Animals Have Higher Cellular Density in the Healing Anterior Cruciate Ligament than Adolescent or Adult Animals  

PubMed Central

There has been recent interest in the biologic stimulation of anterior cruciate ligament (ACL) healing. However, the effect of age on the ability of ligaments to heal has not yet been defined. In this study, we hypothesized that skeletal maturity would significantly affect the cellular and vascular repopulation rate of an ACL wound site. Skeletally Immature (open physes), Adolescent (closing physes), and Adult (closed physes) Yucatan minipigs underwent bilateral ACL transection and suture repair using a collagen-platelet composite. The response to repair was evaluated histologically at 1, 2, and 4 weeks. All three groups of animals had completely populated the ACL wound site with fibroblasts at 1 week. The Immature animals had a higher cellular density in the wound site than the Adult animals at weeks 2 and 4. Cells in the Immature ligament wounds were larger and more ovoid than in the Adult wounds. There were no significant differences in the vascular density in the wound site. Animal age had a significant effect on the density of cells populating the ACL wound site. Whether this observed cellular difference has an effect on the later biomechanical function of the repaired ACL requires further study. PMID:20127960

Mastrangelo, Ashley N.; Haus, Brian M.; Vavken, Patrick; Palmer, Matthew P.; Machan, Jason T.; Murray, Martha M.

2010-01-01

325

Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up study  

Microsoft Academic Search

Rehabilitation after anterior cruciate ligament (ACL) reconstruction has focused over the past decade on closed kinetic chain (CKC) exercises due to presumably less strain on the graft than with isokinetic open kinetic chain exercises (OKC); however, recent reports suggest that there are only minor differences in ACL strain values between some CKC and OKC exercises. We studied anterior knee laxity,

C. Mikkelsen; S. Werner; E. Eriksson

2000-01-01

326

Eight clinical conundrums relating to anterior cruciate ligament (ACL) injury in sport: recent evidence and a personal reflection.  

PubMed

Over two million anterior cruciate ligament (ACL) injuries occur worldwide annually, and the greater prevalence for ACL injury in young female athletes is one of the major problems in sports medicine. Optimal treatment of ACL injury requires individualised management. Patient selection is of utmost importance, and so is respect for the patient's functional demands and interests. All patients with an ACL tear may not need surgery, however athletes and persons with an active lifestyle with high knee functional demands including cutting motions need and should be offered surgery. In many cases it may not be the choice of graft or technique that is the key for success, but the choice of surgeon. The surgeon should be experienced and use a reconstructive procedure he/she knows very well and is comfortable with. The development of osteoarthritis after an ACL injury depends very much on the injury mechanism and concurrent meniscal injury, as knee articular cartilage continues to heal for 1-2 years after an ACL injury. Therefore the surgeon and rehabilitation team must pay attention to the rehabilitation process and to the decision when to return to sport. Return to sport must be carefully considered, as top-level sport in itself is one main risk factor for osteoarthritis after ACL injury. The present criteria for return to sport need to be revisited, also due to the fact that recurrent injury seems to be an increasing problem. ACL injury prevention programmes are now available in some sports. The key issue for a prevention programme to be successful is proper implementation. Vital factors for success include the individual coaching of the player and well controlled compliance with the training programme. Preventive activities should be more actively supported by the involved athletic community. Despite substantial advances in the field of ACL injury over the past 40 years, substantial management challenges remain. PMID:22942168

Renström, Per A

2013-04-01

327

Effect of Anteromedial Portal Entrance Drilling Angle during Anterior Cruciate Ligament Reconstruction: A Three-Dimensional Computer Simulation  

PubMed Central

Purpose The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. Materials and Methods Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. Results In tunnels drilled at a coronal angle of 45°, an axial angle of 45°, and a sagittal angle of 45°, the mean femoral tunnel length was 39.5±3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4±2.6 mm. The tunnel length at a coronal angle of 30°, an axial angle of 60°, and a sagittal angle of 45°, was 34.0±2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7±1.3 mm, which was significantly shorter than the standard angle (p<0.001). Conclusion Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal. PMID:25323895

Moon, Dong Kyu; Yoon, Chul Ho; Park, Jin Seung; Kang, Bun Jung; Cho, Seong Hee; Jo, Ho Seung

2014-01-01

328

Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial  

PubMed Central

Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

2013-01-01

329

Association Between Previous Meniscal Surgery and the Incidence of Chondral Lesions at Revision Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. Hypothesis Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. Study design Cohort study (Prevalence); Level of evidence, 2. Methods Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. Results The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ? .03). Conclusion The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may reflect underlying differences in the knee at the time of prior surgery, it does suggest that meniscal repair is preferable when possible at the time of ACL reconstruction. PMID:22374942

Brophy, Robert H.; Wright, Rick W.; David, Tal S.; McCormack, Robert G.; Sekiya, Jon K.; Svoboda, Steven J.; Huston, Laura J.; Haas, Amanda K.; Steger-May, Karen

2013-01-01

330

Risk factors for Anterior Cruciate Ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging  

PubMed Central

The necessity for identification of risk factors for Anterior Cruciate Ligament, ACL injury has challenged many investigators. Many authors have reported lower Notch Width Index, NWI measured on radiographs in patients with midsubstance ACL lesions compared to control groups. Since a narrow intercondylar notch has been implicated as a possible risk factor related to ACL injury we decided to compare NWI measured on MRI scans between age-matched groups with acute ACL injury with those of the normal population. The purpose of this study was to measure intercondylar notch width on MRI scans in an immature population to determine if there was a difference between the population with ACL tears and a control group. We also wanted to assess age as a risk factor in an ACL injury population. We retrospectively analysed the MRI scans of 46 patients with ACL injuries and 44 patients with normal MRI findings who served as a control group for NWI measurements. For the ACL injury group we collected information from medical charts including age at the time of injury, gender, mechanism of injury, type of activity practised at the time of injury and prevalence of meniscal injury. Demographic data of the control group were comparable with those from the study group. We found a statistically significant (p?

Grzelak, Piotr; Gabos, Peter

2010-01-01

331

Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries.  

PubMed

In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of degenerative changes. We compared the post-operative (minimum 5 years) clinical and radiological outcomes of 50 patients, similar for ACL rupture and meniscal tears, but different for the grade of cartilage lesion. The patient population was divided into two groups similar for ACL reconstruction and surgical meniscal management. Group 1 included 25 patients undergoing microfracture management of grade III-IV cartilage lesions, while Group 2 included 25 patients with grade I-II cartilage lesions, managed by radiofrequency. Comparing pre- and post-operative status, Lachman test, pivot shift values and KT 1000 side to side difference measurements improved significantly (<.001) in both groups, with NS difference between the two groups (>0.05) at the intermediate and latest assessments. At both post-operative appointments, in both groups, the average Lysholm score and IKDC ranking rates improved significantly (<0.001) compared to pre-operative values, but slight worsening was observed in Group 1 patients at the latest review. At the latest assessment, 10 knees (40%) in Group 1 and 3 knees (15%) in Group 2 demonstrated degenerative changes according to Fairbank grading. Concerning the WOMAC index score and sport activity level rating, Group 1 patients had significantly lower scores than Group 2 patients (P < 0.05). In patients with symptomatic ACL instability combined to grade III-IV cartilage lesions, microfractures give excellent short-term clinical and functional improvement but do not prevent the evolution of degenerative changes. PMID:20111955

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Amato, Cirino; Denaro, Vincenzo; Maffulli, Nicola

2010-10-01

332

Effects of articular cartilage and meniscus injuries at the time of surgery on osteoarthritic changes after anterior cruciate ligament reconstruction in patients under 40 years old  

Microsoft Academic Search

Introduction  The development of osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction is an unsolved problem. Articular\\u000a cartilage and meniscus injuries are particularly important factors that contribute to OA progression.\\u000a \\u000a \\u000a \\u000a Aim  The purpose of this study was to investigate how articular cartilage and meniscus injuries at the time of surgery affected\\u000a the development of OA under limited conditions retrospectively. Exclusion criteria of

Atsushi Ichiba; Ikuo Kishimoto

2009-01-01

333

Selective contribution of each hamstring muscle to anterior cruciate ligament protection and tibiofemoral joint stability in leg-extension exercise: a simulation study.  

PubMed

A biomechanical model was developed to simulate the selective effect of the co-contraction force provided by each hamstring muscle on the shear and compressive tibiofemoral joint reaction forces, during open kinetic-chain knee-extension exercises. This model accounts for instantaneous values of knee flexion angle [Formula: see text], angular velocity and acceleration, and for changes in magnitude, orientation, and application point of external resistance. The tibiofemoral shear force (TFSF) largely determines the tensile force on anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Biceps femoris is the most effective hamstring muscle in decreasing the ACL-loading TFSF developed by quadriceps contractions for [Formula: see text]. In this range, the semimembranosus generates the dominant tibiofemoral compressive force, which enhances joint stability, opposes anterior/posterior tibial translations, and protects cruciate ligaments. The semitendinosus force provides the greatest decreasing gradient of ACL-loading TFSF for [Formula: see text], and the greatest increasing gradient of tibiofemoral compressive force for [Formula: see text]. However, semitendinosus efficacy is strongly limited by its small physiological section. Hamstring muscles behave as a unique muscle in enhancing the PCL-loading TFSF produced by quadriceps contractions for [Formula: see text]. The levels of hamstrings co-activation that suppress the ACL-loading TFSF considerably shift when the knee angular acceleration is changed while maintaining the same level of knee extensor torque by a concurrent adjustment in the magnitude of external resistance. The knowledge of the specific role and the optimal activation level of each hamstring muscle in ACL protection and tibiofemoral stability are fundamental for planning safe and effective rehabilitative knee-extension exercises. PMID:23670482

Biscarini, Andrea; Botti, Fabio Massimo; Pettorossi, Vito Enrico

2013-09-01

334

Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol  

PubMed Central

Background: Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated. Study Design: Case series. Hypothesis: A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery. Methods: Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests. Results: The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation. Conclusions: Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players. PMID:23016064

Della Villa, Stefano; Boldrini, Lorenzo; Ricci, Margherita; Danelon, Furio; Snyder-Mackler, Lynn; Nanni, Gianni; Roi, Giulio Sergio

2012-01-01

335

Motor control strategies during double leg squat following anterior cruciate ligament rupture and reconstruction: an observational study  

PubMed Central

Background Anterior cruciate ligament (ACL) injured individuals often show asymmetries between the injured and non-injured leg. A better understanding of the underlying motor control could help to improve rehabilitation. Double leg squat exercises allow for compensation strategies. This study therefore investigated motor control strategies during a double leg squat with the aim to investigate if individuals with ACL rupture (ACLD), ACL reconstruction (ACLR) and healthy control subjects (CONT) used different strategies. Methods 20 ACLD and 21 ACLR were compared to 21 CONT subjects. Participants performed eight continuous double leg squats to their maximum depth, while kinematic and kinetic data were collected. Outcome measures were calculated to quantify the behavior of the injured and non-injured legs and the asymmetry between these legs. Results Squat depth was significantly reduced in ACLR and ACLD compared to CONT (p?

2014-01-01

336

The potential use of enamel matrix derivative for in situ anterior cruciate ligament tissue engineering: a translational in vitro investigation.  

PubMed

Polyester scaffolds have been used as an alternative to autogenous tissues for the reconstruction of the anterior cruciate ligament (ACL). They are biocompatible and encourage tissue infiltration, leading to neoligament formation. However, rupture can occur, caused by abrasion of the scaffold against the bone tunnels through which it is implanted. Good early tissue induction is therefore considered essential to protect the scaffold from this abrasion. Enamel matrix derivative (EMD) is used clinically in the treatment of periodontal disease. It is a complex mix of proteins with growth factor-like activity, which enhances periodontal ligament fibroblast attachment, proliferation, and differentiation, leading to the regeneration of periodontal bone and ligament tissues. We hypothesized that EMD might, in a similar manner, enhance tissue induction around scaffolds used in ACL reconstruction. This preliminary investigation adopted a translational approach, modelling in vitro 3 possible clinical modes of EMD administration, to ascertain the suitability of each protocol for application in an animal model or clinically. Preliminary investigations in monolayer culture indicated that EMD had a significant dose-dependent stimulatory effect (p < 0.05, n = 6) on the proliferation of bovine primary synovial cells. However, pre-treating culture plates with EMD significantly inhibited cell attachment (p < 0.01, n = 6). EMD's effects on synovial cells, seeded onto ligament scaffolds, were then investigated in several in vitro experiments modelling 3 possible modes for clinical EMD administration (pre-, intra-, and post-operative). In the pre-operative model, EMD was adsorbed onto scaffolds before the addition of cells. In the intra-operative model, EMD and cells were added simultaneously to scaffolds in the culture medium. In the post-operative model, cells were pre-seeded onto scaffolds before EMD was administered. EMD significantly inhibited cell adhesion in the pre-operative model (p < 0.05, n = 6) and had no significant benefit in the intra-operative model. In the post-operative model, the addition of EMD to previously cell-seeded scaffolds significantly increased their total deoxyribonucleic acid content (p < 0.01, n = 5). EMD's stimulative effect on cell proliferation in vitro suggests that it may accelerate scaffold colonization by cells (and in turn tissue induction) in situ. However, its inhibitory effect on synovial cell attachment in vitro implies that it may only be suited to post-operative administration. PMID:17518724

Messenger, Michael P; Raif, El Mustafa; Seedhom, Bahaa B; Brookes, Steven J

2007-08-01

337

A Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury  

PubMed Central

STUDY DESIGN Prospective cohort study without a control group. OBJECTIVES Firstly, to present our 5-week progressive exercise therapy program in the early stage after anterior cruciate ligament (ACL) injury. Secondly, to evaluate changes in knee function after completion of the program for patients with ACL injury in general and also when classified as potential copers or noncopers, and, finally, to examine potential adverse events. BACKGROUND Few studies concerning early-stage ACL rehabilitation protocols exist. Consequently, little is known about the tolerance for, and outcomes from, short-term exercise therapy programs in the early stage after injury. METHODS One-hundred patients were included in a 5-week progressive exercise therapy program, within 3 months after injury. Knee function before and after completion of the program was evaluated from isokinetic quadriceps and hamstrings muscle strength tests, 4 single-leg hop tests, 2 different self-assessment questionnaires, and a global rating of knee function. A 2-way mixed-model analysis of variance was conducted to evaluate changes from pretest to posttest for the limb symmetry index for muscle strength and single-leg hop tests, and the change in scores for the patient-reported questionnaires. In addition, absolute values and the standardized response mean for muscle strength and single-leg hop tests were calculated at pretest and posttest for the injured and uninjured limb. Adverse events during the 5-week period were recorded. RESULTS The progressive 5-week exercise therapy program led to significant improvements (P<.05) in knee function from pretest to posttest both for patients classified as potential copers and noncopers. Standardized response mean values for changes in muscle strength and single-leg hop performance from pretest to posttest for the injured limb were moderate to strong (0.49–0.84), indicating the observed improvements to be clinically relevant. Adverse events occurred in 3.9% of the patients. CONCLUSION Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation, either to improve knee function before ACL reconstruction or as a first step in further nonoperative management. PMID:20710097

EITZEN, INGRID; MOKSNES, HAVARD; SNYDER-MACKLER, LYNN; RISBERG, MAY ARNA

2011-01-01

338

[Isokinetic assessment with two years follow-up of anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons].  

PubMed

This retrospective multicentric study was designed to assess the outcome of quadriceps and hamstrings muscles two years after Anterior Cruciate Ligament (ACL) reconstruction and compare muscles recovery depending on the type of graft and individual variables like age, gender, level of sport, but also in terms of discomfort, pain and functional score. The results focused on the subjective and objective IKDC scores, SF36, the existence or not of subjective disorders and their location. The review included isokinetic muscle tests concentric and eccentric extensors/flexors but also internal rotators/external rotators with analysis of mean work and mean power. One hundred and twenty-seven patients were included with an average age 29 years (+/-10). They all had an ACL reconstruction with patellar tendon or hamstring tendon with single or double bundles. In the serie, the average muscles deficit at two years was 10% for the flexors and extensors but with a significant dispersion. Significant differences were not noted in the mean values of all parameters in term of sex or age (over 30 years or not), neither the type of sport, nor of clinical assessment (Class A and B of objective IKDC score), nor the existence of anterior knee pain. There was a relationship between the level of extensor or flexor recovery and the quality of functional results with minimal muscle deficits close to 5% if the IKDC score was over 90 and deficits falling to 15% in the group with IKDC score less than 90. The type of reconstruction (patellar tendon versus hamstrings) had an influence on the muscle deficit. For extensors, the recovery was the same in the two groups, more than 90% at two years and the distribution of these two populations by level of deficit was quite the same. For flexors, residual deficits were significantly higher in the hamstrings group on the three studied parameters whatever the speed and the type of contraction (concentric or eccentric) with an average deficit of 14 to 18%, while, in the patellar tendon group, there was a dominance over the opposite side of 2 to 3% in concentric contraction. The hamstrings deficit appears to be "harvest dependent". For internal rotators, a significantly higher deficit is observed in eccentric contraction for the hamstrings group. The residual hamstrings deficits were related to the number of tendons harvested: -7% when there was no harvest, 7% with one tendon harvested and 17% with two tendons harvested. The relationship between the level of recovery of the quadriceps muscle and hamstrings at two years and the quality of functional results incite, regarding the significantly higher deficit of flexors in ACL reconstructions with hamstrings, to change the rehabilitation programs and especially on early rehabilitation of hamstrings in eccentric mode in the early weeks postoperative considering the harvest site as an equivalent of muscle tear. PMID:19046696

Condouret, J; Cohn, J; Ferret, J-M; Lemonsu, A; Vasconcelos, W; Dejour, D; Potel, J-F

2008-12-01

339

Balance index score as a predictive factor for lower sports results or anterior cruciate ligament knee injuries in Croatian female athletes--preliminary study.  

PubMed

Female athletes participating in high-risk sports suffer anterior cruciate ligament (ACL) knee injury at a 4- to 6-fold greater rate than do male athletes. ACL injuries result either from contact mechanisms or from certain unexplained non-contact mechanisms occurring during daily professional sports activities. The occurrence of non-contact injuries points to the existence of certain factors intrinsic to the knee that can lead to ACL rupture. When knee joint movement overcomes the static and the dynamic constraint systems, non-contact ACL injury may occur. Certain recent results suggest that balance and neuromuscular control play a central role in knee joint stability, protection and prevention of ACL injuries. The purpose of this study is to evaluate balance neuromuscular skills in healthy Croatian female athletes by measuring their balance index score, as well as to estimate a possible correlation between their balance index score and balance effectiveness. This study is conducted in an effort to reduce the risk of future injuries and thus prevent female athletes from withdrawing from sports prematurely. We analysed fifty-two female athletes in the high-risk sports of handball and volleyball, measuring for their static and dynamic balance index scores, using the Sport KAT 2000 testing system. This method may be used to monitor balance and coordination systems and may help to develop simpler measurements of neuromuscular control, which can be used to estimate risk predictors in athletes who withdraw from sports due to lower sports results or ruptured anterior cruciate ligament and to direct female athletes to more effective, targeted preventive interventions. The tested Croatian female athletes with lower sports results and ACL knee injury incurred after the testing were found to have a higher balance index score compared to healthy athletes. We therefore suggest that a higher balance index score can be used as an effective risk predictor for lower sports results and lesser sports motivation, anterior cruciate ligament injury and the ultimate decision to withdraw from active participation in sports. If the balance testing results prove to be effective in predicting the occurrence of ligament injuries during future sports activities, we suggest that prophylactic training programs be introduced during athlete training, since the prevention of an initial injury will be more effective than prevention of injury recurrence. PMID:17598410

Vrbani?, Tea Schnurrer-Luke; Ravli?-Gulan, Jagoda; Gulan, Gordan; Matovinovi?, Damir

2007-03-01

340

Arthroscopic Surgery.  

ERIC Educational Resources Information Center

Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

Connors, G. Patrick

341

Magnetic resonance imaging analysis of the bioabsorbable Milagro™ interference screw for graft fixation in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Ligament graft fixation with bioabsorbable interference screws is a standard procedure in cruciate ligament replacement. Previous\\u000a screw designs may resorb incompletely, and can cause osteolysis and sterile cysts despite being implanted for several years.\\u000a The aim of this study was to examine the in vivo degradation and biocompatibility of the new Milagro™ interference screw (Mitek,\\u000a Norderstedt, Germany). The Milagro™ interference screw

K.-H. Frosch; T. Sawallich; G. Schütze; A. Losch; T. Walde; P. Balcarek; F. Konietschke; K. M. Stürmer

2009-01-01

342

Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique  

PubMed Central

Purpose The purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI) findings of a reconstructed anterior cruciate ligament (ACL) have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee. Methods This study is a level II, prospective clinical and MRI study (NCT02000258). The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used. Results We found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations. Conclusion Anterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this has no effect on the clinical recovery of the patient. PMID:25249760

Suomalainen, Piia; Kiekara, Tommi; Moisala, Anna-Stina; Paakkala, Antti; Kannus, Pekka; Jarvela, Timo

2014-01-01

343

A comparison of pain scores and medication use in patients undergoing single-bundle or double-bundle anterior cruciate ligament reconstruction  

PubMed Central

Background No gold standard exists for the management of postoperative pain following anterior cruciate ligament reconstruction (ACLR). We compared the pain scores and medication use of patients undergoing single-bundle (SB) or double-bundle (DB) ACLR in the acute postoperative period. Pain and medication use was also analyzed for spinal versus general anesthesia approaches within both surgery types. Methods We assessed 2 separate cohorts of primary ACLR patients, SB and DB, for 14 days postoperatively. We used a standard logbook to record self-reported pain scores and medication use. Pain was assessed using a 100 mm visual analogue scale (VAS). Medications were divided into 3 categories: oral opioids, oral nonsteroidal anti-inflammatories and acetaminophen. Results A total of 88 patients undergoing SB and 41 undergoing DB ACLR were included in the study. We found no significant difference in VAS pain scores between the cohorts. Despite similar VAS pain scores, the DB cohort consumed significantly more opioid and analgesia medication (p = 0.011). Patients who underwent DB with spinal anesthesia experienced significantly less pain over the initial 14-day postoperative period than those who received general anesthesia (p < 0.001). Conclusion Adequate pain relief was provided to all ACLR patients in the initial postoperative period. Patients in the DB cohort experienced more pain, as evidenced by the significant difference in consumption of opioids and acetaminophen, than the SB cohort. Patients who underwent spinal anesthesia experienced less pain in the acute postoperative period than those who received general anesthesia. PMID:24869623

Macdonald, Simon A.; Heard, S. Mark; Hiemstra, Laurie A.; Buchko, Gregory M.L.; Kerslake, Sarah; Sasyniuk, Treny M.

2014-01-01

344

Manual Khalifa Therapy in Patients with Completely Ruptured Anterior Cruciate Ligament in the Knee: First Results from Near-Infrared Spectroscopy  

PubMed Central

Background: Manual Khalifa therapy has been practiced in Hallein, Austria, for more than 30 years; however, there are no scientific results available on the topic. Aims: The goal of the present study was to investigate possible acute effects of Khalifa therapy on regional oxygen saturation of knee tissues in patients with completely ruptured anterior cruciate ligament. Materials and Methods: We investigated 10 male patients (mean age ± standard deviation (SD) 35.9 ± 6.1 year) using a four-channel oximeter. The sensors were applied anterolaterally and anteromedially, beside the patella, on both the injured and the healthy (control) knee. Results: The results of the controlled study showed that values of oxygen saturation on the knee with the ruptured ligament were significantly increased (P < 0.001) immediately after Khalifa therapy, whereas the values on the control knee showed insignificant increases. Baselines values of the anterolateral side of the injured knee were significantly (P < 0.001) different from those of the anterolateral side of the control knee. The same effect was present on the anteromedial side; however, with a lower degree of significance (P < 0.05). Conclusions: Khalifa therapy was clinically successful in all 10 patients. Further, investigations and analyzes are necessary to explain the underlying mechanism. PMID:23814763

Litscher, Gerhard; Ofner, Michael; Litscher, Daniela

2013-01-01

345

Protective effects of calcium gluconate on osteoarthritis induced by anterior cruciate ligament transection and partial medial meniscectomy in Sprague-Dawley rats  

PubMed Central

Background This study aimed to determine whether calcium gluconate exerts protective effects on osteoarthritis (OA) induced by anterior cruciate ligament (ACL) transection and partial medial meniscectomy. Methods Calcium gluconate was administered by mouth daily for 84 days to male ACL transected and partial medial meniscectomized Sprague–Dawley rats 1 week after operation. Results Eighty-four days of treatment with 50 mg/kg calcium gluconate led to a lower degree of articular stiffness and cartilage damage compared to the OA control, possibly through inhibition of overexpressed cyclooxygenase (COX)-2 and related chondrocyte apoptosis. Similar favorable effects on stiffness and cartilage were detected in calcium gluconate-administered rats. Additionally, calcium gluconate increased 5-bromo-2?-deoxyuridine (BrdU) uptake based on observation of BrdU-immunoreactive cells on both the femur and tibia articular surface cartilages 84 days after intra-joint treatment with calcium gluconate. Conclusions Taken together, our results demonstrate that calcium gluconate has a protective effect against OA through inhibition of COX-2 and related chondrocyte apoptosis. PMID:24602500

2014-01-01

346

A decreased volume of the medial tibial spine is associated with an increased risk of suffering an anterior cruciate ligament injury for males but not females.  

PubMed

Measurements of tibial plateau subchondral bone and articular cartilage slope have been associated with the risk of suffering anterior cruciate ligament (ACL) injury. Such single-plane measures of the tibial plateau may not sufficiently characterize its complex, three-dimensional geometry and how it relates to knee injury. Further, the tibial spines have not been studied in association with the risk of suffering a non-contact ACL injury. We questioned whether the geometries of the tibial spines are associated with non-contact ACL injury risk, and if this relationship is different for males and females. Bilateral MRI scans were acquired on 88 ACL-injured subjects and 88 control subjects matched for sex, age and sports team. Medial and lateral tibial spine geometries were characterized with measurements of length, width, height, volume and anteroposterior location. Analyses of females revealed no associations between tibial spine geometry and risk of ACL injury. Analyses of males revealed that an increased medial tibial spine volume was associated with a decreased risk of ACL injury (OR?=?0.667 per 100?mm(3) increase). Smaller medial spines could provide less resistance to internal rotation and medial translation of the tibia relative to the femur, subsequently increasing ACL strains and risk of ACL injury. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1451-1457, 2014. PMID:24962098

Sturnick, Daniel R; Argentieri, Erin C; Vacek, Pamela M; DeSarno, Michael J; Gardner-Morse, Mack G; Tourville, Timothy W; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J; Beynnon, Bruce D

2014-11-01

347

Manual Khalifa Therapy Improves Functional and Morphological Outcome of Patients with Anterior Cruciate Ligament Rupture in the Knee: A Randomized Controlled Trial  

PubMed Central

Rupture of the anterior cruciate ligament (ACL) is a high incidence injury usually treated surgically. According to common knowledge, it does not heal spontaneously, although some claim the opposite. Regeneration therapy by Khalifa was developed for injuries of the musculoskeletal system by using specific pressure to the skin. This randomized, controlled, observer-blinded, multicentre study was performed to validate this assumption. Thirty patients with complete ACL rupture, magnetic resonance imaging (MRI) verified, were included. Study examinations (e.g., international knee documentation committee (IKDC) score) were performed at inclusion (t0). Patients were randomized to receive either standardised physiotherapy (ST) or additionally 1 hour of Khalifa therapy at the first session (STK). Twenty-four hours later, study examinations were performed again (t1). Three months later control MRI and follow-up examinations were performed (t2). Initial status was comparable between both groups. There was a highly significant difference of mean IKDC score results at t1 and t2. After 3 months, 47% of the STK patients, but no ST patient, demonstrated an end-to-end homogeneous ACL in MRI. Clinical and physical examinations were significantly different in t1 and t2. ACL healing can be improved with manual therapy. Physical activity can be performed without pain and nearly normal range of motion after one treatment of specific pressure. PMID:24600477

Kastner, Andreas; Wallenboeck, Engelbert; Pehn, Robert; Schneider, Frank; Groell, Reinhard; Szolar, Dieter; Walach, Harald; Sandner-Kiesling, Andreas

2014-01-01

348

Eminence-based medicine versus evidence-based medicine: is anterior cruciate ligament reconstruction optimally performed with the double-bundle technique?  

PubMed

The anterior cruciate ligament (ACL) comprises 2 distinct bands or bundles-the anteromedial bundle, which is tighter in flexion, and the posterolateral bundle, which is tighter in extension. Traditional ACL reconstruction uses 1 graft. A new technique, known as the double-bundle technique, uses 2 tendon grafts to more closely approximate normal anatomy. Because the medical literature does not provide a definitive answer as to which reconstruction method is better, we surveyed 500 experts in sports medicine in a previous study to determine whether they agreed with the statement "ACL reconstruction is optimally performed with the double-bundle technique." Respondents were inclined to answer "This statement is probably false." Our article interprets the expert responses by reviewing the basic and clinical sciences implicit in the question and reviewing the literature regarding outcomes. We found that double-bundle ACL reconstruction is theoretically appealing, but evidence proving that it improves clinical outcomes is unavailable. High-quality studies are under way on the topic, which may provide a definitive answer. However, until such data are available, the expert consensus from our survey was that the double-bundle technique is not necessarily the optimal approach. PMID:23445865

Massey, Paul R; Tjoumakaris, Fotios P; Bernstein, Joseph

2013-02-01

349

Metabolic profiling of synovial fluid in a unilateral ovine model of anterior cruciate ligament reconstruction of the knee suggests biomarkers for early osteoarthritis.  

PubMed

Joint injuries and subsequent osteoarthritis (OA) are the leading causes of chronic joint disease. In this work, we explore the possibility of applying magnetic resonance spectroscopy-based metabolomics to detect host responses to an anterior cruciate ligament (ACL) reconstruction injury in synovial fluid in an ovine model. Using multivariate statistical analysis, we were able to distinguish post-injury joint samples (ACL and sham surgery) from the uninjured control samples, and as well the ACL surgical samples from sham surgery. In all samples there were 65 metabolites quantified, of which six could be suggested as biomarkers for early post-injury degenerative changes in the knee joints: isobutyrate, glucose, hydroxyproline, asparagine, serine, and uridine. Our results raise a cautionary note indicating that surgical interventions into the knee can result in metabolic alterations that need to be distinguished from those caused by the early onset of OA. Our findings illustrate the potential application of metabolomics as a diagnostic and prognostic tool for detection of injuries to the knee joint. The ability to detect a unique pattern of metabolic changes in the synovial fluid of sheep offers the possibility of extending the approach to precision medicine protocols in patient populations in the future. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:71-77, 2015. PMID:25283885

Mickiewicz, Beata; Heard, Bryan J; Chau, Johnny K; Chung, May; Hart, David A; Shrive, Nigel G; Frank, Cyril B; Vogel, Hans J

2015-01-01

350

Geometric profile of the tibial plateau cartilage surface is associated with the risk of non-contact anterior cruciate ligament injury.  

PubMed

The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non-contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case-control analysis. Seventy-eight subjects who suffered a non-contact ACL tear and a corresponding number of controls matched by age, sex, and sport underwent 3 T MRI of both knees. Surface geometry of the tibial articular cartilage was characterized with polynomial equations and comparisons were made between knees on the same person and between ACL-injured and control subjects. There was no difference in surface geometry between the knees of the control subjects. In contrast, there were significant differences in the surface geometry between the injured and normal knees of the ACL-injured subjects, suggesting that the ACL injury changed the cartilage surface profile. Therefore, comparisons were made between the uninjured knees of the ACL-injured subjects and the corresponding knees of their matched controls and this revealed significant differences in the surface geometry for the medial (p < 0.006) and lateral (p < 0.001) compartments. ACL-injured subjects tended to demonstrate a posterior-inferior directed orientation of the articular surface relative to the long axis of the tibia, while the control subjects were more likely to show a posterior-superior directed orientation. PMID:24123281

Beynnon, Bruce D; Vacek, Pamela M; Sturnick, Daniel R; Holterman, Leigh Ann; Gardner-Morse, Mack; Tourville, Timothy W; Smith, Helen C; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J

2014-01-01

351

From the gait laboratory to the rehabilitation clinic: translation of motion analysis and modeling data to interventions that impact anterior cruciate ligament loads in gait and drop landing.  

PubMed

In female athletes the risk of anterior cruciate ligament (ACL) injury during impact-related activities such as landing is higher compared to males. Both how and why this occurs has been at the forefront of orthopedic sports medicine research over the past 20 years. Many individuals with an ACL-deficient knee compensate for joint instability in an effort to remain physically active. Yet others do not compensate and are faced with a reduction in their activities and/or meniscus tears and eventually osteoarthritis. In this article we attempt to link 2 distinct but related scientific disciplines (in vivo motion analysis assessment and computational modeling) to show how these techniques have emerged as powerful tools in our understanding of knee function. Normal knee function and the biomechanics of the ACL-deficient (ACLd) and ACL-reconstructed (ACLr) knee are summarized. Basic experiments concerning the mechanism of noncontact ACL injury as well as performance adaptations in ACLd and ACLr knees are reviewed, and the biomechanics of the normal, ACLd, and ACLr knees under more strenuous activities, such as landing from a jump, are provided. PMID:24579646

Kernozek, Thomas; Torry, Michael; Shelburne, Kevin; Durall, Christopher J; Willson, John

2013-01-01

352

Meta-analysis of In vitro and Intra-operative Laxities after Single Bundle and Double Bundle Anterior Cruciate Ligament Reconstructions  

PubMed Central

Purpose The purpose of this study was to objectively evaluate if the double bundle ACL reconstruction can better restore the normal translational and rotational laxities than the conventional single bundle ACL reconstruction among the reported biomechanical studies. Methods A systematic literature search was conducted to identify in vitro and in vivo (intra-operative) biomechanical studies that compared the laxities (anterior or anteroposterior or rotational) between single and double bundle ACL reconstructions. Due to a large variability among the loading conditions and testing methods used to determine the rotational laxities between the studies, a meta-analysis of rotational laxities was not feasible. Results Seven in vitro and three in vivo studies were included in this analysis based on the predefined inclusion criteria. The overall mean difference calculated by the random effects model in the anteroposterior laxity between the single bundle and double bundle ACL reconstruction techniques at 0°, 30°, 60° and 90° of flexion were 0.99 mm, 0.38 mm, 0.34 mm, and 0.07 mm respectively. No statistical significant difference was noted between the two treatments at all flexion angles. Among the nine studies that compared the rotational laxity of single bundle and double bundle ACL reconstructions, four studies reported that double bundle reconstruction can provide a better rotational control compared to the single bundle reconstruction. The other five studies could not identify any significant difference between the two reconstructions in terms of the rotational laxity. Conclusions Both single and double bundle treatment options for anterior cruciate ligament injury result in similar anteroposterior knee joint laxity at time-zero. No 1 conclusive evidence on the superiority of one reconstruction technique over the other in terms of rotation laxity can be obtained due to several variations in the experimental protocol and the parameters used to measure the rotational laxity among the studies. Level of Evidence Level III PMID:21624681

Gadikota, Hemanth R; Seon, Jong Keun; Chen, Chih-Hui; Wu, Jia-Lin; Gill, Thomas J; Li, Guoan

2010-01-01

353

Visualization and reduction of a mensical capsular junction tear in the knee: an arthroscopic surgical technique.  

PubMed

Meniscal injuries commonly occur concomitantly with anterior cruciate ligament (ACL) injuries. Although many types of meniscal injuries have been described in the literature, there has not been much focus on meniscal capsular junction (MCJ) tears. This lack of attention is concerning given that, in a survey of 67 orthopedic surgeons, 88% indicated that MCJ tears could be a source of chronic pain. In addition, we reviewed 781 ACL reconstructions at our clinic and found a 12.3% incidence of MCJ tear with primary ACL injury and a 23.6% incidence of MCJ tear with revision ACL reconstruction. In this article, we describe an arthroscopic repair technique for MCJ tears at the posterior aspect of the medial meniscus root. The repair uses an accessory posterior medial portal. The technique can also be used for significant posterior medial capsular tears. PMID:25379745

Plymale, Mickey; Fleisig, Glenn S; Kocaj, Stephen M; Cooney, William P; Evans, Timothy J; Cain, E Lyle; Dugas, Jeffrey R

2014-11-01

354

Fifteen-year follow-up of arthroscopic partial meniscectomy.  

PubMed

From an original pool of 283 patients, 146 patients who had undergone arthroscopic partial meniscectomy an average of 14.7 years before were followed-up. Lysholm score, Tegner activity level, satisfaction index on a scale of 1 to 10, and standing anteroposterior and flexion weight-bearing radiographs of both knees, were obtained. A physical examination was performed on each knee emphasizing motion, swelling, and ligament evaluation. Radiographs were graded for degenerative changes for each knee. Each knee joint space was also measured in millimeters and compared, operative knee with unoperated knee. The unoperated knee had no injuries or surgeries and was used as a control. Patients were 83% male and 17% female; 78% had undergone medial meniscectomies, 19% lateral, and 3% both. There were 88% good and excellent results in anterior cruciate ligament-stable knees. The radiographic grade side-to-side difference showed the operative knee to be only a 0.23 grade worse than the nonoperative knee. Age at the time of meniscectomy was not found to be a factor. Male patients had better radiographic results than female patients, but not better functional scores. Medial meniscus and lateral meniscus results were not significantly different. Knees with a femoral-tibial anatomic alignment of > 0 degree valgus compared with < or = 0 degree and that had undergone medial meniscectomy had significantly better radiographic results. Patients with anterior cruciate ligament tears and meniscectomy did significantly poorer than stable knees with meniscectomy in regards to radiographic grade change, Lysholm, satisfaction index, Tegner level, and medial joint space narrowing. PMID:9442319

Burks, R T; Metcalf, M H; Metcalf, R W

1997-12-01

355

The biomechanics of cruciate ligament repair  

E-print Network

originates from the inside (medial) surface of the lateral condyle of the femur and extends diagonally across the joint space to insert onto the craniomedial tibial plateau (Figure 1). The CrCL in canines corresponds to the anterior cruciate ligament (ACL...) in humans. 1 cranial cruciate ligament 2 caudal cruciate ligament 3 medial meniscus 4 lateral meniscus (r 1 5 meniscofemoral ligament 6 infrapatellar body fat 7 lateral collateral ligament 8 medial collateral ligament From: Adams, Donald R. (1986...

Ferry, Katheryn Irene

2013-02-22

356

The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament  

PubMed Central

Objective The objective of this study was to evaluate the incidence of radiographic osteoarthritis in the operated knee in comparison with the contralateral knee ten years after a bone-tendon bone patellar autograft ACL-reconstruction and to evaluate to which level patients regain activity ten years after reconstruction. Methods Fifty-three patients with ACL instability were operated arthroscopically using the central third of the patellar tendon as a bone-tendon-bone autograft. At a minimum of 10 year follow up 28/44 patients matched the inclusion criteria and could be reached for follow-up. Evaluation included a patient satisfaction evaluation using a Visual Analog Scale, physical examination (International Knee Documentation Committee score, Tegner score, Lysholm score, KT-1000 stabilometry) and a radiological evaluation (Kellgren and Fairbanks classification). Results The patients' satisfaction, at a mean of 10,3 year follow-up, measured with a VAS score (0–10) was high with a mean of 8.5 (range 4 to 10). The KT 1000 arthrometer laxity measurements revealed in 55% of the patients an A rating (1–2 mm), in 29% a B rating (3–5 mm) and in 16% a C rating (6–10 mm). According to the Tegner score 54% of the patients were able to perform at the same activity level as pre-operatively. The mean pre-operative Tegner score was 6.8 and the mean post-operative Tegner score was 6.0 at final follow up. The Lysholm score showed satisfactory results with a mean of 91 points (range 56 to 100). According to the Kellgren and Fairbank classifications, there is a significant difference (p < 0.05) in development of OA between the ACL injured and subsequently operated knee in comparison to the contralateral knee. Conclusion The patellar BTB ACL reconstruction does not prevent the occurrence of radiological OA after 10 years but does help the patient to regain the pre-operative level of activity. PMID:18544170

van der Hart, Cor P; van den Bekerom, Michel PJ; Patt, Thomas W

2008-01-01

357

Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial  

Microsoft Academic Search

BACKGROUND: The efficacy of selective cox-2 inhibitors in postoperative pain reduction were usually compared with conventional non-selective conventional NSAIDs or other types of medicine. Previous studies also used selective cox-2 inhibitors as single postoperative dose, in continued mode, or in combination with other modalities. The purpose of this study was to compare analgesic efficacy of single preoperative administration of etoricoxib

Tanarat Boonriong; Boonsin Tangtrakulwanich; Prapakorn Glabglay; Sasikaan Nimmaanrat

2010-01-01

358

A numerical simulation approach to studying anterior cruciate ligament strains and internal forces among young recreational women performing valgus inducing stop-jump activities.  

PubMed

Anterior cruciate ligament (ACL) injuries are commonly incurred by recreational and professional women athletes during non-contact jumping maneuvers in sports like basketball and volleyball, where incidences of ACL injury is more frequent to females compared to males. What remains a numerical challenge is in vivo calculation of ACL strain and internal force. This study investigated effects of increasing stop-jump height on neuromuscular and bio-mechanical properties of knee and ACL, when performed by young female recreational athletes. The underlying hypothesis is increasing stop-jump (platform) height increases knee valgus angles and external moments which also increases ACL strain and internal force. Using numerical analysis tools comprised of Inverse Kinematics, Computed Muscle Control and Forward Dynamics, a novel approach is presented for computing ACL strain and internal force based on (1) knee joint kinematics and (2) optimization of muscle activation, with ACL insertion into musculoskeletal model. Results showed increases in knee valgus external moments and angles with increasing stop-jump height. Increase in stop-jump height from 30 to 50 cm lead to increase in average peak valgus external moment from 40.5 ± 3.2 to 43.2 ± 3.7 Nm which was co-incidental with increase in average peak ACL strain, from 9.3 ± 3.1 to 13.7 ± 1.1%, and average peak ACL internal force, from 1056.1 ± 71.4 to 1165.4 ± 123.8 N for the right side with comparable increases in the left. In effect this study demonstrates a technique for estimating dynamic changes to knee and ACL variables by conducting musculoskeletal simulation on motion analysis data, collected from actual stop-jump tasks performed by young recreational women athletes. PMID:22527014

Kar, Julia; Quesada, Peter M

2012-08-01

359

Differences in anterior cruciate ligament elasticity and force for knee flexion in women: oral contraceptive users versus non-oral contraceptive users.  

PubMed

Eighty-two percent of sexually active women aged 15-44 have used oral contraceptive pills (OCP) in the United States. The OCP, an exogenous source of synthetic forms of steroid hormones, prevents ovulation. Hormone changes during the menstrual cycle (MC) are believed to have an impact on anterior cruciate ligament (ACL) laxity due to estrogen. Because the estrogen receptor ? resides on human connective tissue, OCP may have potential impact on tendon and ligament synthesis, structure, and biomechanical properties. Temperature has also been known to have an effect on tissue elasticity. Therefore, the purpose of this study was to investigate the differences in ACL elasticity, force to flex the knee (FFK), and knee flexion-extension hysteresis (KFEH) between OCP users and non-OCP users. To investigate these changes, two different knee temperatures were measured. Nineteen young females were divided into two groups: OCP users and non-OCP users. Blood for estradiol serum concentration (E2) was taken before beginning the tests. ACL elasticity, FFK, and KFEH were assessed both at ambient temperature (22 °C) and after 38 °C warming of the leg to stabilize tissue temperature. Assessments were performed four times during the MC. Throughout the MC, ACL elasticity, FFK, and KFEH fluctuated in non-OCP users, but not in OCP users. At ambient temperature, ACL elasticity was significantly lower and FFK and KFEH were significantly higher in OCP users than non-OCP users (p < 0.05). But, no significant differences in FFK and KFEH between the two groups were found after warming to 38 °C. PMID:24240566

Lee, Haneul; Petrofsky, Jerrold S; Daher, Noha; Berk, Lee; Laymon, Michael

2014-02-01

360

Elevated gastrocnemius forces compensate for decreased hamstrings forces during the weight-acceptance phase of single-leg jump landing: implications for anterior cruciate ligament injury risk.  

PubMed

Approximately 320,000 anterior cruciate ligament (ACL) injuries in the United States each year are non-contact injuries, with many occurring during a single-leg jump landing. To reduce ACL injury risk, one option is to improve muscle strength and/or the activation of muscles crossing the knee under elevated external loading. This study?s purpose was to characterize the relative force production of the muscles supporting the knee during the weight-acceptance (WA) phase of single-leg jump landing and investigate the gastrocnemii forces compared to the hamstrings forces. Amateur male Western Australian Rules Football players completed a single-leg jump landing protocol and six participants were randomly chosen for further modeling and simulation. A three-dimensional, 14-segment, 37 degree-of-freedom, 92 muscle-tendon actuated model was created for each participant in OpenSim. Computed muscle control was used to generate 12 muscle-driven simulations, 2 trials per participant, of the WA phase of single-leg jump landing. A one-way ANOVA and Tukey post-hoc analysis showed both the quadriceps and gastrocnemii muscle force estimates were significantly greater than the hamstrings (p<0.001). Elevated gastrocnemii forces corresponded with increased joint compression and lower ACL forces. The elevated quadriceps and gastrocnemii forces during landing may represent a generalized muscle strategy to increase knee joint stiffness, protecting the knee and ACL from external knee loading and injury risk. These results contribute to our understanding of how muscle?s function during single-leg jump landing and should serve as the foundation for novel muscle-targeted training intervention programs aimed to reduce ACL injuries in sport. PMID:25218505

Morgan, Kristin D; Donnelly, Cyril J; Reinbolt, Jeffrey A

2014-10-17

361

Effect on ligament marker expression by direct-contact co-culture of mesenchymal stem cells and anterior cruciate ligament cells.  

PubMed

Ligament and tendon repair is an important topic in orthopedic tissue engineering; however, the cell source for tissue regeneration has been a controversial issue. Until now, scientists have been split between the use of primary ligament fibroblasts or marrow-derived mesenchymal stem cells (MSCs). The objective of this study was to show that a co-culture of anterior cruciate ligament (ACL) cells and MSCs has a beneficial effect on ligament regeneration that is not observed when utilizing either cell source independently. Autologous ACL cells (ACLcs) and MSCs were isolated from Yorkshire pigs, expanded in vitro, and cultured in multiwell plates in varying %ACLcs/%MSCs ratios (100/0, 75/25, 50/50, 25/75, and 0/100) for 2 and 4 weeks. Quantitative mRNA expression analysis and immunofluorescent staining for ligament markers Collagen type I (Collagen-I), Collagen type III (Collagen-III), and Tenascin-C were performed. We show that Collagen-I and Tenascin-C expression is significantly enhanced over time in 50/50 co-cultures of ACLcs and MSCs (p?0.03), but not in other groups. In addition, Collagen-III expression was significantly greater in MSC-only cultures (p?0.03), but the Collagen-I-to-Collagen-III ratio in 50% co-culture was closest to native ligament levels. Finally, Tenascin-C expression at 4 weeks was significantly higher (p?0.02) in ACLcs and 50% co-culture groups compared to all others. Immunofluorescent staining results support our mRNA expression data. Overall, 50/50 co-cultures had the highest Collagen-I and Tenascin-C expression, and the highest Collagen-I-to-Collagen-III ratio. Thus, we conclude that using a 50% co-culture of ACLcs and MSCs, instead of either cell population alone, may better maintain or even enhance ligament marker expression and improve healing. PMID:22780864

Canseco, Jose A; Kojima, Koji; Penvose, Ashley R; Ross, Jason D; Obokata, Haruko; Gomoll, Andreas H; Vacanti, Charles A

2012-12-01

362

A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system.  

PubMed

We conducted a prospective randomised study of anatomical single-bundle (A-SB group) versus double-bundle (A-DB group) anterior cruciate ligament (ACL) reconstruction using the hamstrings tendons. Twenty patients with unilateral ACL deficiency were randomised into two groups. We created the bone tunnels at the position of the original insertion of the anteromedial bundle footprint and posterolateral bundle footprint in the A-DB group and at the central position between these two bundles in the A-SB group. All of the patients were tested before ACL reconstruction and one year after surgery. The KT-1000 measurements, isokinetic muscle peak torque and heel-height difference were evaluated and the general knee condition was assessed by Lysholm score. For pre- and postoperative stability assessment, we used the six-degrees-of-freedom of knee kinematic measurement system using an electromagnetic device (the EMS) for quantitative assessment during the Lachman test and the pivot shift test. There were no significant differences in the KT-1000 measurements, isokinetic muscle peak torque, heel-height difference, and Lysholm score at one-year follow-up between these two groups. The EMS data showed there were significant differences in the acceleration of the pivot shift test between the operated knee and the contralateral normal knees in the A-SB group. In conclusion, clinical outcomes were equally good in both groups. However, the EMS data showed the anatomical double-bundle ACL reconstruction tended to be biomechanically superior to the single-bundle reconstruction. PMID:20734043

Araki, Daisuke; Kuroda, Ryosuke; Kubo, Seiji; Fujita, Norifumi; Tei, Katsumasa; Nishimoto, Koji; Hoshino, Yuichi; Matsushita, Takehiko; Matsumoto, Tomoyuki; Nagamune, Koki; Kurosaka, Masahiro

2011-03-01

363

Rebound Pain Scores as a Function of Femoral Nerve Block Duration after Anterior Cruciate Ligament Reconstruction: Retrospective Analysis of a Prospective, Randomized Clinical Trial  

PubMed Central

Background and objectives Continuous perineural femoral analgesia has been reported to reduce numeric rating pain scores (NRS, scale zero to 10) after anterior cruciate ligament reconstruction (ACLR). In the current study, we determined rebound pain scores in autograft ACLR outpatients after nerve block analgesia resolved. Methods After standardized spinal anesthesia and perioperative multimodal analgesia, patients received a femoral perineural catheter and 50 hours of saline or levobupivacaine. All patients received levobupivacaine (30 mL of 0.25% as a bolus) before the infusion. Patients completed a pain diary for 6 days, indicating serial NRS scores and perceptions of when nerve block analgesia resolved. Block duration and rebound pain scores were computed. Results Data from 84 participants’ pain diaries were analyzed. Patients receiving saline infusion reported mean nerve block duration of 37 hours, versus 59 hours for patients receiving the levobupivacaine infusion (P<0.001). Mean Rebound Pain Scores increased by 2.0 (95% CI: 1.6, 2.4). Based on the computations used to derive block duration and rebound pain scores, each hour of additional block duration was predictive of a 0.03 unit reduction in rebound pain scores. Conclusions In an anesthesia care protocol consisting of spinal anesthesia and multimodal analgesia during and after autograft ACL reconstruction, approximately 33 hours of additional nerve block duration were required to reduce rebound pain scores by one unit. Further study is required to determine rebound pain score differences when other local anesthetics and anesthetic/analgesic plans are being used, and when other surgeries are being performed. PMID:17543812

Williams, Brian A.; Bottegal, Matthew T.; Kentor, Michael L.; Irrgang, James J.; Williams, John P.

2007-01-01

364

Effect on Ligament Marker Expression by Direct-Contact Co-culture of Mesenchymal Stem Cells and Anterior Cruciate Ligament Cells  

PubMed Central

Ligament and tendon repair is an important topic in orthopedic tissue engineering; however, the cell source for tissue regeneration has been a controversial issue. Until now, scientists have been split between the use of primary ligament fibroblasts or marrow-derived mesenchymal stem cells (MSCs). The objective of this study was to show that a co-culture of anterior cruciate ligament (ACL) cells and MSCs has a beneficial effect on ligament regeneration that is not observed when utilizing either cell source independently. Autologous ACL cells (ACLcs) and MSCs were isolated from Yorkshire pigs, expanded in vitro, and cultured in multiwell plates in varying %ACLcs/%MSCs ratios (100/0, 75/25, 50/50, 25/75, and 0/100) for 2 and 4 weeks. Quantitative mRNA expression analysis and immunofluorescent staining for ligament markers Collagen type I (Collagen-I), Collagen type III (Collagen-III), and Tenascin-C were performed. We show that Collagen-I and Tenascin-C expression is significantly enhanced over time in 50/50 co-cultures of ACLcs and MSCs (p?0.03), but not in other groups. In addition, Collagen-III expression was significantly greater in MSC-only cultures (p?0.03), but the Collagen-I-to-Collagen-III ratio in 50% co-culture was closest to native ligament levels. Finally, Tenascin-C expression at 4 weeks was significantly higher (p?0.02) in ACLcs and 50% co-culture groups compared to all others. Immunofluorescent staining results support our mRNA expression data. Overall, 50/50 co-cultures had the highest Collagen-I and Tenascin-C expression, and the highest Collagen-I-to-Collagen-III ratio. Thus, we conclude that using a 50% co-culture of ACLcs and MSCs, instead of either cell population alone, may better maintain or even enhance ligament marker expression and improve healing. PMID:22780864

Canseco, Jose A.; Kojima, Koji; Penvose, Ashley R.; Ross, Jason D.; Obokata, Haruko; Gomoll, Andreas H.

2012-01-01

365

Mechanisms of the Anterior Cruciate Ligament Injury in Sports Activities: A Twenty-Year Clinical Research of 1,700 Athletes  

PubMed Central

The mechanisms of anterior cruciate ligament (ACL) injuries are still inconclusive from an epidemiological standpoint. An epidemiological approach in a large sample group over an appropriate period of years will be necessary to enhance the current knowledge of the ACL injury mechanism. The objective of the study was to investigate the ACL injury occurrence in a large sample over twenty years and demonstrate the relationships between the ACL injury occurrence and the dynamic knee alignment at the time of the injury. We investigated the activity, the injury mechanism, and the dynamic knee alignment at the time of the injury in 1,718 patients diagnosed as having the ACL injuries. Regarding the activity at the time of the injury, “competition ”was the most common, accounting for about half of all the injuries. The current result also showed that the noncontact injury was the most common, which was observed especially in many female athletes. Finally, the dynamic alignment of “Knee-in & Toe- out ”(i.e. dynamic knee valgus) was the most common, accounting for about half. These results enhance our understanding of the ACL injury mechanism and may be used to guide future injury prevention strategies. Key points We investigated the situation of ACL injury occurrence, especially dynamic alignments at the time of injury, in 1,718 patients who had visited our institution for surgery and physical therapy for twenty years. Our epidemiological study of the large patient group revealed that “knee-in & toe-out ”alignment was the most frequently seen at the time of the ACL injury. From an epidemiological standpoint, we need to pay much attention to avoiding “Knee-in & Toe-out ”alignment during sports activities. PMID:24149795

Kobayashi, Hirokazu; Kanamura, Tomonao; Koshida, Sentaro; Miyashita, Koji; Okado, Tsuruo; Shimizu, Takuya; Yokoe, Kiyoshi

2010-01-01

366

Anterior cruciate ligament reconstruction with double-looped semitendinosus and gracilis tendon graft directly fixed to cortical bone: 5-year results.  

PubMed

Forty-three patients who had undergone an anterior cruciate ligament (ACL) reconstruction using a doubled semitendinosus and gracilis graft were prospectively reviewed at 5-year follow-up. All had suffered subacute or chronic tears of the ligament. At surgery, the femoral tunnel was drilled first through the antero-medial portal. The correct position of the femoral and tibial guide wire was checked fluoroscopically. A cortical fixation to the bone was achieved in the femur with a Mitek anchor, directly passing the two tendons in the slot of the anchor, and in the tibia with an RCI screw, supplemented with a spiked washer and bicortical screw. Rehabilitation was aggressive, controlled and without braces. The International Knee Documentation Committee (IKDC) form, KT-1000 arthrometer, and Cybex dynamometer were employed for clinical evaluation. A radiographic study was also performed. At the 5-year follow-up all the patients had recovered full range of motion and 2% of them complained of pain during light sports activities. Four patients (9.5%) reported giving-way symptoms. The KT-1000 side-to-side difference was on average 2.1 mm at 30 lb, and 68% of the knees were within 2 mm. The final IKDC score showed 90% satisfactory results. There was no difference between the 2-year and 5-year evaluations in terms of stability. Extensor and flexor muscle strength recovery was almost complete (maximum deficit 5%). Radiographic study showed a tunnel widening in 32% of the femurs and 40% of the tibias. A correlation was found between the incidence of tibial tunnel widening and the distance of the RCI screw from the joint (the closer the screw to the joint, the lower the incidence of widening). In conclusion, we can state that, using a four-strand hamstring graft and a cortical fixation at both ends, we were able to achieve satisfactory 5-year results in 90% of the patients. PMID:15756612

Giron, Francesco; Aglietti, Paolo; Cuomo, Pierluigi; Mondanelli, Nicola; Ciardullo, Antonio

2005-03-01

367

Comparison of Bioabsorbable Suture Anchor Fixation on the Tibial Side for Anterior Cruciate Ligament Reconstruction Using Free Soft Tissue Graft: Experimental Laboratory Study on Porcine Bone  

PubMed Central

Purpose The use of graft tissue fixation using bioabsorbable interference screws (BISs) in anterior cruciate ligament (ACL) reconstruction offers various advantages, but limited pullout strength. Therefore, additional tibial fixation is essential for aggressive rehabilitation. We hypothesized that additional graft tissue fixation using bioabsorbable suture anchors (BSA) would provide sufficient pull-out strength. Materials and Methods Twenty four fresh frozen porcine distal femur and patellar tendon preparations were used. All specimens were divided into three groups based on additional fixation methods: A, isolated BIS; B, BIS and BSA; and C, BIS and post cortical screw. Tensile testing was carried out under an axial load. Ultimate failure load and ultimate failure load after cyclic loading were recorded. Results The ultimate failure loads after load to failure testing were 166.8 N in group A, 536.4 N in group B, and 438 N in group C; meanwhile, the ultimate failure loads after load to failure testing with cyclic loading were 140 N in group A, 466.5 N in group B, and 400 N in group C. Stiffness after load to failure testing was 16.5 N/mm in group A, 33.5 N/mm in group B, and 40 N/mm in group C. An additional BSA fixation resulted in a significantly higher ultimate failure load and stiffness than isolated BIS fixation, similar to post screw fixation. Conclusion Additional fixation using a BSA provided sufficient pullout strength for ACL reconstruction. The ultimate failure load of the BSA technique was similar to that of post cortical screws. PMID:24719145

Na, Suk In; Lee, Jong Min; Park, Ju Yong

2014-01-01

368

Time to Stabilization of Anterior Cruciate Ligament-Reconstructed Versus Healthy Knees in National Collegiate Athletic Association Division I Female Athletes  

PubMed Central

Abstract Context: Jump landing is a common activity in collegiate activities, such as women's basketball, volleyball, and soccer, and is a common mechanism for anterior cruciate ligament (ACL) injury. It is important to better understand how athletes returning to competition after ACL reconstruction are able to maintain dynamic postural control during a jump landing. Objective: To use time to stabilization (TTS) to measure differences in dynamic postural control during jump landing in ACL-reconstructed (ACLR) knees compared with healthy knees among National Collegiate Athletic Association Division I female athletes. Design: Case-control study. Setting: University athletic training research laboratory. Patients or Other Participants: Twenty-four Division I female basketball, volleyball, and soccer players volunteered and were assigned to the healthy control group (n ?=? 12) or the ACLR knee group (n ?=? 12). Participants with ACLR knees were matched to participants with healthy knees by sport and by similar age, height, and mass. Intervention(s): At 1 session, participants performed a single-leg landing task for both limbs. They were instructed to stabilize as quickly as possible in a single-limb stance and remain as motionless as possible for 10 seconds. Main Outcome Measure(s): The anterior-posterior TTS and medial-lateral TTS ground reaction force data were used to calculate resultant vector of the TTS (RVTTS) during a jump landing. A 1-way analysis of variance was used to determine group differences on RVTTS. The means and SDs from the participants' 10 trials in each leg were used for the analyses. Results: The ACLR group (2.01 ± 0.15 seconds, 95% confidence interval [CI] ?=? 1.91, 2.10) took longer to stabilize than the control group (1.90 ± 0.07 seconds, 95% CI ?=? 1.86, 1.95) (F1,22 ?=? 4.28, P ?=? .05). This result was associated with a large effect size and a 95% CI that did not cross zero (Cohen d ?=? 1.0, 95% CI ?=? 0.91, 1.09). Conclusions: Although they were Division I female athletes at an average of 2.5 years after ACL reconstruction, participants with ACLR knees demonstrated dynamic postural-control deficits as evidenced by their difficulty in controlling ground reaction forces. This increased TTS measurement might contribute to the established literature reflecting differences in single-limb dynamic control. Clinicians might need to focus rehabilitation efforts on stabilization after jump landing. Further research is needed to determine if TTS is a contributing factor in future injury. PMID:21062181

Webster, Kathryn A.; Gribble, Phillip A.

2010-01-01

369

Hoffa’s fat pad injuries and their relationship with anterior cruciate ligament tears: new observations based on MR imaging in patients and MR imaging and anatomic correlation in cadavers  

Microsoft Academic Search

Purpose  To determine the normal anatomic relationships of Hoffa’s fat pad with the anterior cruciate ligament (ACL) and with the frequency\\u000a of Hoffa’s fat pad abnormalities in ACL-deficient knees.\\u000a \\u000a \\u000a \\u000a Design  Retrospective clinical study on patients and observational anatomic study on cadavers. The study was approved by the Institutional\\u000a Review Board.\\u000a \\u000a \\u000a \\u000a Patients  MR imaging studies of the knees of 100 patients (21–48 years old) with

Marcelo R. Abreu; Christine B. Chung; Debra Trudell; Donald Resnick

2008-01-01

370

Arthroscopic delivery of cancellous tibial autograft for unstable osteochondral lesions in the adolescent knee.  

PubMed

The appropriate surgical technique for the treatment of unstable osteochondral lesions of the knee remains unclear and had been traditionally described with an open arthrotomy. Administration of bone grafting material in the knee may be performed for a variety of pathologic conditions, including unstable osteochondritis dissecans, traumatic osteochondral defects, or subchondral fracture nonunion, or for preparation of residual tunnels during revision anterior cruciate ligament reconstruction. Although various grafting materials have been described in the literature, cancellous autograft remains the gold standard for treatment safety and efficacy. We describe a successful technique for arthroscopic delivery of autogenous bone graft during fixation of unstable osteochondral lesions of the knee. When the indication for grafting is established, cancellous autograft is harvested from the proximal tibia, undergoes morcellation, and is soaked in bone marrow aspirate obtained through the harvest window. The bone graft is then packed into a modified tuberculin syringe. After arthroscopic preparation of the unstable osteochondral fragment and the respective donor surface, the tuberculin syringe is placed through a standard arthroscopy portal and the bone graft is introduced into the defect under direct visualization, followed by an appropriate osteochondral fixation technique. PMID:25126499

Espinoza, Chris; Ellis, Henry B; Wilson, Philip

2014-06-01

371

Combined in vivo/in vitro method to study anteriomedial bundle strain in the anterior cruciate ligament using a dynamic knee simulator.  

PubMed

The mechanism of noncontact anterior cruciate ligament (ACL) injury is not well understood. It is partly because previous studies have been unable to relate dynamic knee muscle forces during sports activities such as landing from a jump to the strain in the ACL. We present a combined in vivo/in vitro method to relate the muscle group forces to ACL strain during jump-landing using a newly developed dynamic knee simulator. A dynamic knee simulator system was designed and developed to study the sagittal plane biomechanics of the knee. The simulator is computer controlled and uses six powerful electromechanical actuators to move a cadaver knee in the sagittal plane and to apply dynamic muscle forces at the insertion sites of the quadriceps, hamstring, and gastrocnemius muscle groups and the net moment at the hip joint. In order to demonstrate the capability of the simulator to simulate dynamic sports activities on cadaver knees, motion capture of a live subject landing from a jump on a force plate was performed. The kinematics and ground reaction force data obtained from the motion capture were input into a computer based musculoskeletal lower extremity model. From the model, the force-time profile of each muscle group across the knee during the movement was extracted, along with the motion profiles of the hip and ankle joints. This data was then programmed into the dynamic knee simulator system. Jump-landing was simulated on a cadaver knee successfully. Resulting strain in the ACL was measured using a differential variable reluctance transducer (DVRT). Our results show that the simulator has the capability to accurately simulate the dynamic sagittal plane motion and the dynamic muscle forces during jump-landing. The simulator has high repeatability. The ACL strain values agreed with the values reported in the literature. This combined in vivo/in vitro approach using this dynamic knee simulator system can be effectively used to study the relationship between sagittal plane muscle forces and ACL strain during dynamic activities. PMID:24231822

Cassidy, Karla; Hangalur, Gajendra; Sabharwal, Preet; Chandrashekar, Naveen

2013-03-01

372

Muscle morphometric effect of anterior cruciate ligament injury measured by computed tomography: aspects on using non-injured leg as control  

PubMed Central

Background Anterior cruciate ligament (ACL) tears are common, functionally disabling, and predispose to subsequent injuries and early onset of osteoarthritis in the knee. Injuries result in muscular atrophy and impaired muscular activation. To optimize surgical methods and rehabilitation strategies, knowledge of the effects of ACL injuries on muscles size and function is needed. Asymmetry due to limb dominance implies that the effect of ACL-injury might be different in right-sided and left-sided injuries which, should be taken in account when evaluating the effect of an injury. Evaluation of the effects of injuries is usually made with the contralateral leg as control. The aim of this study is to describe the effect of ACL-injuries on thigh muscle size and also to analyze feasibility of using contralateral limb as control. Methods Sixty-two patients scheduled to undergo ACL reconstruction were examined with computed tomography (CT). Muscle cross sectional area (CSA) was recorded for quadriceps, hamstrings, gracilis and sartorius 15 cm above the knee joint. Comparisons were made between the injured and non-injured side and between individuals separated by gender and side of injury. Comparisons were also made for patients with or without concomitant meniscal tear, for patients differing in time between injury and examinations and for patients with different level of physical activity after the injury. Results Quadriceps CSA was 5% smaller on the injured side. There was an indication that the muscles of the right thigh were generally bigger than those of the left thigh. The difference between the injured and the non-injured side was larger for right-sided injuries than for left-sided. There was also a greater difference in semimembranosus for women than for men. There were no differences related to meniscal injury, time since injury or physical activity. Conclusion The use of contralateral leg for evaluating the effect of ACL-injury is often the only available alternative but our study indicates that the difference in CSA between injured and non-injured side does not necessarily reflect the true degree of atrophy, as there are side differences both in muscle size in general and in the effect of an ACL-injury on muscle size. PMID:23628130

2013-01-01

373

Effects of Suture Choice on Biomechanics and Physeal Status After Bioenhanced Anterior Cruciate Ligament Repair in Skeletally Immature Patients: A Large-Animal Study  

PubMed Central

Purpose The objective of this study was to assess the effect of absorbable or nonabsorbable sutures in bioenhanced anterior cruciate ligament (ACL) repair in a skeletally immature pig model on suture tunnel and growth plate healing and biomechanical outcomes. Methods Sixteen female skeletally immature Yorkshire pigs were randomly allocated to receive unilateral, bioenhanced ACL repair with an absorbable (Vicryl) or nonabsorbable (Ethibond) suture augmented by an extracellular matrix-based scaffold (MIACH). After 15 weeks of healing, micro–computed tomography was used to measure residual tunnel diameters and growth plate status, and biomechanical outcomes were assessed. Results At 15 weeks postoperatively, there was a significant difference in tunnel diameter with significantly larger diameters in the nonabsorbable suture group (4.4 ± 0.3 mm; mean ± SD) than in the absorbable group (1.8 ± 0.5 mm; P <.001). The growth plate showed a significantly greater affected area in the nonabsorbable group (15.2 ± 3.4 mm2) than in the absorbable group (2.7 ± 0.8 mm2, P < .001). There was no significant difference in the linear stiffness of the repairs (29.0 ± 14.8 N/mm for absorbable v 43.3 ± 28.3 N/mm for nonabsorbable sutures, P = .531), but load to failure was higher in the nonabsorbable suture group (211 ± 121.5 N) than in the absorbable suture group (173 ± 101.4 N, P =.002). There was no difference between the 2 groups in anteroposterior laxity at 30° (P = .5117), 60° (P = .3150), and 90° (P = .4297) of knee flexion. Conclusions The use of absorbable sutures for ACL repair resulted in decreased physeal plate damage after 15 weeks of healing; however, use of nonabsorbable sutures resulted in 20% stronger repairs. Clinical Relevance Choice of suture type for ACL repair or repair of tibial avulsion fractures may depend on patient skeletal age and size, with absorbable sutures preferred in very young, small patients at higher risk with physeal damage and nonabsorbable sutures preferred in larger, prepubescent patients who may place higher loads on the repair. PMID:23200845

Vavken, Patrick; Proffen, Benedikt; Peterson, Chris; Fleming, Braden C.; Machan, Jason T.; Murray, Martha M.

2012-01-01

374

Femoral tunnel-interference screw divergence in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: A comparison of two techniques  

PubMed Central

Background: Interference screw is a popular fixation device used to rigidly fix bone-patellar tendon-bone (B-PT-B) graft both in femoral and tibial tunnels in anterior cruciate ligament (ACL) reconstruction. Parallel placement of screw is difficult in transtibially drilled femoral tunnel but always desired as it affects pullout strength of the graft. Commonly, interference screw into the femoral tunnel is inserted through the anteromedial (AM) or accessory AM portal. These portals are not-in-line with the transtibially drilled femoral tunnel. Furthermore, these portals increase the divergence of the interference screw in the femoral tunnel. We hypothesized that interference screw placement through patellar tendon (PT) portal (through donor defect) in transtibially drilled femoral tunnel can be less divergent. We report the prospective randomized study to investigate the difference of divergence of interference screw placed through PT portal and AM portal and its clinical relevance. Materials and Methods: Forty-one patients underwent femoral tunnel B-PT-B graft fixation through AM portal (group 1) and other 41 (group 2) through PT portal. Femoral tunnel-interference screw divergence was measured on postoperative digital lateral X-rays. Ha’s method was used to grade divergence. The clinical outcome was assessed by postoperative intervention knee documentation committee grading (IKDC) and Lysholm score at 2 years followup. Results: Mean tunnel-screw divergence in sagittal plane through AM portal was 13.38° (95% CI: 12.34-14.41) and through PT portal was 7.20° (95% CI: 6.25-8.16) (P<0.0001). In AM portal group, 82.9% patients had divergence in either grade 3 or 4 category, whereas in PT portal group, 82.9% patients were in grade 1 or 2 category (P<0.0001). Mean Lysholm score were 92.8 and 94.5 at two-year follow-up in both groups which were statistically not significant. The International knee documentation committee grades of patients in both groups were similar and had no statistical significance. Conclusion: Femoral interference screw placement through the PT portal leads to significantly less screw divergence as compared with screw placement through the AM portal. However, this difference in divergence is not reflected in clinical outcome. PMID:21559106

Pandey, Vivek; Acharya, Kiran; Rao, Sharath; Rao, Sripathi

2011-01-01

375

Anterior glenohumeral joint dislocations.  

PubMed

The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthroidal joint. Anterior dislocation is by far the most common direction and can lead to instability of the glenohumeral joint, which ranges from subtle increased laxity to recurrent dislocation. Overtime, understanding of anterior shoulder dislocations and the resulting instability has improved. Likewise, significant advances in arthroscopic equipment have allowed use of the arthroscope to address anatomically the various lesions that cause instability. This article reviews the anatomy, pathophysiology, clinical evaluation, and treatment of anterior shoulder instability. PMID:18803980

Dodson, Christopher C; Cordasco, Frank A

2008-10-01

376

Anterior Cruciate Ligament (ACL) Injuries  

MedlinePLUS

... ACL injury: Lachman test. During this exam, a person will lie down flat on his or her back with the affected knee lifted and flexed at a 20- to 30-degree angle. The doctor then places one hand on the person's calf and the other on the top of ...

377

Arthroscopic surgery of the knee.  

PubMed Central

In the first 1000 arthroscopic operations performed by one surgeon 136 patients had two or more procedures, making a total of 1168 during the 1000 operations. The indications for operation were internal mechanical derangements in 565 patients, anterior knee pain in 246, disorders of the synovium in 77, ligament injuries in 63, and degenerative joint disease in 49. Complications included fracture of instruments in the knee in five patients, haemarthrosis in 10, deep vein thrombosis in three, and synovial fistula in one. In no patient was the wound infected. A total of 26 different operations was performed. PMID:6812832

Dandy, D J; O'Carroll, P F

1982-01-01

378

Arthroscopic meniscal repair: a comparative study between three different surgical techniques.  

PubMed

The purpose of this prospective study was to evaluate and compare the results of arthroscopic meniscal repair using three different techniques. Between January 2002 and March 2004, 57 patients who met the inclusion criteria underwent an arthroscopic meniscal repair. The outside-in technique was used in 17 patients (group A), the inside-out in 20 patients (group B), while the rest of the 20 patients (group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All meniscal repairs were considered healed according to our criteria in group A, while 19 out of 20 repairs (95%) healed in group B. Finally 7 of 20 repairs (35%) were considered failures in group C and this difference was statistically significant in comparison with other groups. The time required for meniscal repair averaged 38.5 min for group A, 18.1 min for group B, and 13.6 min for group C. Operation time for meniscal repair in group A was statistically longer in comparison with other groups. There were no significant differences among the three groups concerning complications. According to our results, arhtroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time. PMID:16858558

Hantes, Michael E; Zachos, Vasilios C; Varitimidis, Sokratis E; Dailiana, Zoe H; Karachalios, Theophilos; Malizos, Konstantinos N

2006-12-01

379

Meniscal transplant combined withanterior cruciate ligament reconstruction  

Microsoft Academic Search

The meniscal cartilage plays a vital role in maintaining normal knee function. This important structure providesshock absorption, stabilization, lubrication, proprioception, and load sharing to the knee joint. Although it has been shown that an anterior cruciate ligament (ACL) reconstruction can provide symptomatic pain relief in the arthritic knee, the results following ACL reconstruction in a medial meniscus-deficient knee are usually

Jon K. Sekiya; Hussein A. Elkousy; Christopher D. Harner

2002-01-01

380

Tensile properties of the human femur-anterior cruciate ligament-tibia complexThe effects of specimen age and orientation  

Microsoft Academic Search

The structural properties of 27 pairs of human cadaver knees were evaluated. Specimens were equally divided into three groups of nine pairs each based on age: younger (22 to 35 years), middle (40 to 50 years), and older (60 to 97 years). Anterior-posterior displacement tests with the intact knee at 30° and 90° of flexion revealed a significant effect of

Savio L.-Y. Woo; J. Marcus Hollis; Douglas J. Adams; Roger M. Lyon; Shinro Takai

1991-01-01

381

How the fixation method stiffness and initial tension affect anterior load-displacement of the knee and tension in anterior cruciate ligament grafts: a study in cadaveric knees using a double-loop hamstrings graft.  

PubMed

There were two objectives to this study. The first was to investigate the relationship of graft fixation stiffness and graft initial tension on the anterior load-displacement behavior of knees reconstructed with a double-loop hamstrings tendon graft. The second was to determine the corresponding graft tensions at 225 N of anterior force applied to the knee. To satisfy these objectives, the anterior-load displacement curves were measured for seven cadaveric knees with the ACL intact at flexion angles ranging from 0 degrees to 90 degrees. The ACL was reconstructed in the same knees using a double-loop hamstrings graft. A/P load-displacement curves of the knee and graft tension were measured as the fixation method stiffness and the initial tension applied at full extension were varied (25-326 N/mm and 25-300 N). The 0 N posterior limit (unloaded position of tibia) and the anterior laxity (difference between the 0 N posterior limit and 225 N anterior limit) were computed to characterize the A/P load-displacement of the intact and reconstructed knees. The key results were that the 0 N posterior limit of the tibia was insensitive to changes in stiffness (p>0.6503) but that increasing initial tension caused increasing posterior subluxation of the tibia with respect to the femur (p=0.0001). The tibia was subluxed posteriorly by 5-6 mm on average at high levels of initial tension. Both initial tension and stiffness significantly affected the anterior laxity (p=0.0001 for both factors). Anterior laxity was restored closely to normal (i.e. <1 mm difference) by relatively high initial tension of 200 N in combination with low stiffness of 25 N/mm and by low initial tension of 25 N in combination with higher stiffness ranging between 94 and 326 N/mm. When anterior laxity is restored to normal using a high initial tension-low stiffness combination however, the tibia undergoes a large posterior subluxation with respect to the femur in the unloaded state (approximately 5 mm) and a relatively high graft tension of 275 N is developed at 225 N of anterior force. Both the tibial subluxation and graft tension are reduced substantially with low initial tension-higher stiffness combinations because the amount of initial tension required to restore anterior laxity to normal is reduced by about 200 N. PMID:15099643

Eagar, Paul; Hull, M L; Howell, S M

2004-05-01

382

Functional outcome after open and arthroscopic Bankart repair for traumatic shoulder instability  

PubMed Central

Purpose Both open and arthroscopic Bankart repair are established procedures in the treatment of anterior shoulder instability. While the open procedure is still considered as the "golden standard" functional outcome is supposed to be better in the arthroscopic procedure. The aim of this retrospective study was to compare the functional outcome between open and arthroscopic Bankart repair. Materials and methods In 199 patients a Bankart procedure with suture anchors was performed, either arthroscopically in presence of an detached, but not elongated capsulolabral complex (40) or open (159). After a median time of 31 months (12 to 67 months) 174 patients were contacted and agreed to follow-up, 135 after open and 39 after arthroscopic Bankart procedure. Results Re-dislocations occurred in 8% after open and 15% after arthroscopic Bankart procedure. After open surgery 4 of the 11 re-dislocations occurred after a new adequate trauma and 1 of the 6 re-dislocations after arthroscopic surgery. Re-dislocations after arthroscopic procedure occured earlier than after open Bankart repair. An external rotation lag of 20° or more was observed more often (16%) after open than after arthroscopic surgery (3%). The Rowe score demonstrated "good" or "excellent" functional results in 87% after open and in 80% patients after arthroscopic treatment. Conclusion In this retrospective investigation the open Bankart procedure demonstrated good functional results. The arthroscopic treatment without capsular shift resulted in a better range of motion, but showed a tendency towards more frequently and earlier recurrence of instability. Sensitive patient selection for arthroscopic Bankart repair is recommended especially in patients with more than five dislocations. PMID:19258206

2009-01-01

383

Arthroscopic treatment of antirior synovitis of the ankle in athletes  

Microsoft Academic Search

In a retrospective study we analysed the results of arthroscopic treatment of anterior synovitis of the ankle in 35 athletes. Five athletes additionally suffered from anterior osteophytes, and three presented with an anterolateral plica. Their average age was 25 years (SD 8.3), and the follow-up interval was 32.4 months (SD 19.4). Eight patients suffered from additional hyperlaxity of the ankle

J. Jerosch; J. Steinbeck; M. Schröder; H. Halm

1994-01-01

384

Test-retest reliability [corrected] of center of pressure measures of postural stability during quiet standing in a group with musculoskeletal disorders consisting of low back pain, anterior cruciate ligament injury and functional ankle instability.  

PubMed

Reliability is a population-specific property, but to the authors' knowledge there has been no study to determine the test-retest reliability of the postural stability measures such as center of pressure (COP) measures in the population of patients with musculoskeletal disorders (MSDs), while their clinical applications have been presented in literature. So, 33 patients with low back pain (LBP), anterior cruciate ligament (ACL) injury and functional ankle instability (FAI) randomly completed postural measurements with three levels of difficulty (rigid surface-eyes open, rigid surface-eyes closed, and foam surface-eyes closed) in two sessions. COP data were used to calculate standard deviation of amplitude, standard deviation of velocity, phase plane portrait, mean total velocity and area (95% confidence ellipse). Relative reliability of these measures was assessed using intraclass correlation coefficient (ICC) and absolute reliability using standard error of measurement (SEM) and coefficient of variation (CV). Also, minimal metrically detectable change (MMDC) was calculated to quantify intervention effects. Among different COP parameters, mean total velocity in all conditions of postural difficulty showed high to very high reliability, with ICC range of 0.74-0.91, SEM range of 0.09-0.40cm/s, CV range of 5.31-8.29% and MMDC range of 0.19-0.79cm/s. Phase plane portrait in anteroposterior-mediolateral (AP-ML) and ML direction were other best parameters with respect to the level of reliability. Mean total velocity and phase plane portrait parameters are suggested as good candidates to use for quantification and assessment of balance performance and identifying those with MSDs. PMID:19167891

Salavati, Mahyar; Hadian, Mohammad Reza; Mazaheri, Masood; Negahban, Hossein; Ebrahimi, Ismaeil; Talebian, Saeed; Jafari, Amir Homayoun; Sanjari, Mohammad Ali; Sohani, Soheil Mansour; Parnianpour, Mohamad

2009-04-01

385

Arthroscopic Medial Retinacular Plication With a Needle-Hole Technique  

PubMed Central

Patellar instability is a common problem resulting in anterior knee pain. The medial patellofemoral ligament, which is part of the medial retinaculum, is often injured, and this damaged structure can affect normal patellar movement. Medial retinacular plication can correct this main pathology of patellar instability. Many studies have shown good to excellent results with medial retinacular plication with or without lateral retinacular release. This medial retinacular plication technique can also be performed arthroscopically. Arthroscopic medial reticular plication with a needle-hole technique is a treatment that uses the less invasive technique of arthroscopy, does not require tissue grafts, and has a greater cosmetic advantage than open procedures.

Prasathaporn, Niti; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong

2014-01-01

386

Symptomatic anterior subtalar arthrosis after ankle arthrodesis.  

PubMed

A 76-year-old man reported right lateral heel pain 11 years after ankle arthrodesis. Clinically, there was tenderness in the right sinus tarsi and over the junction point between the talonavicular and calcaneocuboid joints. Radiographs showed that the joint spaces of the posterior subtalar joint and the talonavicular joint were preserved although there were osteophytes at both joints. Arthroscopic findings showed degeneration of the anterior subtalar and talonavicular joints. The symptoms subsided after arthroscopic debridement. PMID:24825553

Lui, Tun Hing

2014-01-01

387

Arthroscopic meniscus repair in the ACL-deficient knee  

Microsoft Academic Search

Between 1985 and 1995, 45 patients underwent closed meniscus repair. There were 30 men and 15 women with a mean age of 32.5 years. In 23 patients, the anterior cruciate ligament was intact (group 1) whereas it was deficient in 22 patients (group 2). All patients were managed with the same postoperative program of partial weight bearing, immediate motion and

F. Steenbrugge; W. Van Nieuwenhuyse; R. Verdonk; K. Verstraete

2005-01-01

388

Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies.  

PubMed

The purpose of our study was that to systematically review the fixation techniques for the ACL reconstruction and associated clinical outcomes at the early follow-up. Systematic search on three electronic databases (Cochrane register, Medline and Embase) of fixation devices used for primary ACL reconstruction with doubled semitendinosus and gracilis and bone-patellar tendon-bone autografts in randomized clinical trials of level I and II of evidence published from January 2001 to December 2011. Therapeutic studies collected were with a minimum 12-month follow-up, and the clinical outcomes were evaluated by at least one of International Knee Documentation Committee, Lysholm and Tegner functional scales and at least one of the following knee stability tests: arthrometric AP tibial translation, Lachman test and pivot-shift test. Nineteen articles met the inclusion criteria. At the femoral side cross-pin, metallic interference screw, bioabsorbable interference screw, and suspensory device were used in 32.3, 27.3, 24.8, 15.5 % of patients, respectively. At the tibial side fixation was achieved with metallic interference screw, bioabsorbable interference screw, screw and plastic sheath, screw post and cross-pin in 38.7, 31, 15.7, 12.8, and 1.7 % of patients, respectively. Side-to-side anterior-posterior tibial translation was 1.9 ± 0.9, 1.5 ± 0.9, 1.5 ± 0.8, 2.2 ± 0.4 mm for metallic interference screw, bioabsorbable screw, cross-pin and suspensory device, respectively. At least two-third of all the patients achieved good-to-excellent clinical outcomes. Rate of failure was 6.1, 3.3, 1.7 and 1.2 % for bioabsorbable interference screw, metallic interference screw, cross-pin and suspensory device, respectively. Clinical outcomes are good to excellent in almost two-third of the patients but several pitfalls that affect the current fixation techniques as graft tensioning such as graft-tunnel motion are still unaddressed. PMID:25269758

Speziali, Andrea; Delcogliano, Marco; Tei, Matteo; Placella, Giacomo; Bartoli, Matteo; Menghi, Amerigo; Cerulli, Giuliano

2014-12-01

389

Outcome of Arthroscopic Repair of Type II SLAP Lesions in Worker’s Compensation Patients  

Microsoft Academic Search

Purpose  Arthroscopic stabilization has become the accepted treatment for type II superior labral anterior and posterior (SLAP) lesions.\\u000a Short-term results using a variety of techniques were promising, but most reports focus on motivated athletes. The purpose\\u000a of our report is to evaluate the results of arthroscopic fixation of type II SLAP lesions in 21 patients who suffered a work-related\\u000a injury and

Nikhil N. Verma; Ralph Garretson; Anthony A. Romeo

2007-01-01

390

Arthroscopic treatment of glenohumeral instability in soccer goalkeepers.  

PubMed

The aim of this study was to report epidemiologic data and results of arthroscopic treatment of glenohumeral instability in soccer goalkeepers. We included 12 soccer goalkeepers with a mean age of 28.9 years (range 18-45 years) with acute or recurrent traumatic anterior instability who underwent an arthroscopic anatomic capsulolabral repair with bone anchors. Patients who underwent surgery within 4 weeks of the first episode of dislocation were classified as acute instability. The results were evaluated using the Rowe Scale and analyzed according to stability, range of motion and function. The mean follow-up was 3.8 years. The most common mechanism of injury (90% of the cases) was abduction, external rotation and extension. Associated injuries were present in 57.2% of recurrent cases and 20% of acute cases (p<0.293). Excellent or good results were observed in 80% of the cases of acute instability and in 57.2% of cases in the group with recurrent instability (p<0.586). From a total of 12 soccer goalkeepers who underwent the arthroscopic capsulolabral repair, good or excellent results were obtained in 66.6% of cases of glenohumeral instability. Surgical arthroscopic repair was possible in all cases of acute or recurrent instability based on well-established inclusion criteria, i. e., with well-defined exclusion criteria, such as HAGL lesion and significant glenohumeral bone loss, the arthroscopic capsulolabral repair can be carried out in soccer goalkeepers. PMID:23143699

Terra, B B; Ejnisman, B; Figueiredo, E A; Andreoli, C V; Pochini, A C; Cohen, C; Arliani, G G; Cohen, M

2013-06-01

391

Arthroscopic Treatment of Knee Fractures  

Microsoft Academic Search

Tibial plateau fractures can be a challenging injury to manage for orthopaedic surgeons. Management of these fractures has\\u000a evolved from immobilization, skeletal traction, open reduction, and internal fixation to (all) arthroscopic reduction and\\u000a internal fixation for some fracture types. Although not all fractures are amenable to arthroscopic reduction and fixation\\u000a techniques, the arthroscope is still an important instrument for intraarticular

S. L. Mortimer; Robert Hunter

392

Anterior Cruciate Ligament (ACL) Injury Prevention  

MedlinePLUS

... control of the knee by the quadriceps and hamstrings muscles in the legs. Researchers are very interested in studying this particular factor since it may be the easiest to modify. HOW DO ACL INJURIES OCCUR? Careful study of videos of athletes tearing ...

393

Physiotherapy after reconstruction of anterior cruciate ligament  

PubMed Central

The purpose of this study was to evaluate the existence of differences in the rehabilitation of patients after ACL reconstruction using bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts, through a literature revision. The researched databases were MEDLINE, EMBASE, LILACS, COCHRANE and PEDro. The inclusion criteria were published studies with methodology draw from randomized clinical trials with or without meta-analysis, individuals with ACL injury, associated or not to meniscal injury, submitted to ligamentoplasty using the bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts and physiotherapy; clinical trials comparing the differences in the rehabilitation of these patients, in Portuguese, English and Spanish, from 1990 to June, 2011. Five clinical trials were reviewed. No difference was observed between the techniques, however, with a recommendation for a less aggressive rehabilitation and greater attention to the strengthening of the hamstring when they are used as grafts. PMID:24453634

Pereira, Maite; Vieira, Neiva de Souza; Brandao, Eduardo da Rosa; Ruaro, Joao Afonso; Grignet, Rodrigo Juliano; Frez, Andersom Ricardo

2012-01-01

394

Patellofemoral problems after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Between 1982 and 1986, 126 patients who had under gone ACL reconstruction were followed in a prospec tive manner. One year follow-up statistics were re viewed for the presence of 13 different complications. The most prevalent complications were quadriceps weakness, flexion contracture, and patellofemoral pain. Quadriceps weakness (strength less than 80% of the normal side) was present in 65% of

Raymond A. Sachs; Dale M. Daniel; Mary Lou Stone; Richard F. Garfein

1989-01-01

395

Anterior cruciate ligament repair - series (image)  

MedlinePLUS

... tissue from the patient’s own body) or an allograft (tissue from a cadaver). One of the most ... the graft in the bone tunnels, although other methods of fixation are used depending on the type ...

396

Anterior cruciate ligament (ACL) injury - aftercare  

MedlinePLUS

... St. Louis, MO: Saunders Elsevier; 2009:chap 23. Miller III RH, Azar, FM. Knee injuires. In: Canale ST, Beaty JH, Daugherty K, Jones L, et al. Canale & Beaty: Campbell's Operative Orthopaedics . 12th ...

397

The resident's ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction.  

PubMed

The purposes of this study were to establish the technique to arthroscopically identify the resident's ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 x 10 mm was created just behind the ridge. At 3-4-weeks post surgery, three-dimensional computed tomography (3-D CT) was performed to geographically identify the location of the ridge using the socket as a reference. Arthroscopically, a linear ridge running from superior-anterior to inferior-posterior on the lateral notch wall was consistently observed 7-10 mm anterior to the posterior articular cartilage margin of the lateral femoral condyle in all of the patients. The 3-D CT pictures proved the arthroscopically identified ridge to be the resident's ridge. The resident's ridge is arthroscopically identifiable after non-mechanical removal of the soft tissues without bony notchplasty. The ridge is a useful landmark for anatomical femoral tunnel drilling in arthroscopic ACL reconstruction. PMID:19915823

Shino, Konsei; Suzuki, Tomoyuki; Iwahashi, Takehiko; Mae, Tatsuo; Nakamura, Norimasa; Nakata, Ken; Nakagawa, Shigeto

2010-09-01

398

Arthroscopic Bony Bankart Fixation Using a Modified Sugaya Technique  

PubMed Central

Arthroscopic fixation of bony Bankart lesions in the setting of anterior shoulder instability has had successful long-term results. Key factors such as patient positioning, portal placement, visualization, mobilization of bony/soft tissues, and anatomic reduction and fixation are crucial to yield such results. We present a modified Sugaya technique that is reproducible and based on such key principles. This technique facilitates ease of anchor and suture placement to allow for anatomic reduction and fixation. PMID:24265994

Gupta, Anil K.; McCormick, Frank M.; Abrams, Geoffrey D.; Harris, Joshua D.; Bach, Bernard R.; Romeo, Anthony A.; Verma, Nikhil N.

2013-01-01

399

Can arthroscopic revision surgery for shoulder instability be a fair option?  

PubMed Central

Summary Background: the aim of this study was to evaluate the role of arthroscopic capsuloplasty in the treatment of failed primary arthroscopic treatment of glenohumeral instability. Methods: we retrospectively examined at a minimum of 3-years follow-up 22 patients who underwent arthroscopic treatment between 1999 and 2007 who had recurrent anterior shoulder instability with a post-surgical failure. A statistical analysis was performed to evaluate which variable could influence the definitive result and clinical outcomes at final follow-up. A p value of less than 0.05 was considered significant. Results: we observed after revision surgery an overall failure rate of 8/22 (36.4%) including frank dislocations, subluxations and also apprehension that seriously inhibit the patient's quality of life. No significant differences were observed in the examined parameters. Conclusions: according to our outcomes we generally do not recommend an arthroscopic revision procedure for failed instability surgery. PMID:25332940

De Giorgi, Silvana; Garofalo, Raffaele; Tafuri, Silvio; Cesari, Eugenio; Rose, Giacomo Delle; Castagna, Alessandro

2014-01-01

400

Contralateral Cruciate Survival in Dogs with Unilateral Non-Contact Cranial Cruciate Ligament Rupture  

PubMed Central

Background Non-contact cranial cruciate ligament rupture (CrCLR) is an important cause of lameness in client-owned dogs and typically occurs without obvious injury. There is a high incidence of bilateral rupture at presentation or subsequent contralateral rupture in affected dogs. Although stifle synovitis increases risk of contralateral CrCLR, relatively little is known about risk factors for subsequent contralateral rupture, or whether therapeutic intervention may modify this risk. Methodology/Principal Findings We conducted a longitudinal study examining survival of the contralateral CrCL in client-owned dogs with unilateral CrCLR in a large baseline control population (n?=?380), and a group of dogs that received disease-modifying therapy with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline (n?=?16), and were followed for one year. Follow-up in treated dogs included analysis of mobility, radiographic evaluation of stifle effusion and arthritis, and quantification of biomarkers of synovial inflammation. We found that median survival of the contralateral CrCL was 947 days. Increasing tibial plateau angle decreased contralateral ligament survival, whereas increasing age at diagnosis increased survival. Contralateral ligament survival was reduced in neutered dogs. Our disease-modifying therapy did not significantly influence contralateral ligament survival. Correlative analysis of clinical and biomarker variables with development of subsequent contralateral rupture revealed few significant results. However, increased expression of T lymphocyte-associated genes in the index unstable stifle at diagnosis was significantly related to development of subsequent non-contact contralateral CrCLR. Conclusion Subsequent contralateral CrCLR is common in client-owned dogs, with a median ligament survival time of 947 days. In this naturally occurring model of non-contact cruciate ligament rupture, cranial tibial translation is preceded by development of synovial inflammation. However, treatment with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline does not significantly influence contralateral CrCL survival. PMID:21998650

Muir, Peter; Schwartz, Zeev; Malek, Sarah; Kreines, Abigail; Cabrera, Sady Y.; Buote, Nicole J.; Bleedorn, Jason A.; Schaefer, Susan L.; Holzman, Gerianne; Hao, Zhengling

2011-01-01

401

Arthroscopic coracoclavicular ligament reconstruction using biologic and suture fixation.  

PubMed

Presented in this report is a modified arthroscopic approach to acromioclavicular joint reconstruction via suture and allograft fixation. An arthroscopic approach is used to expose the base of the coracoid by use of electrocautery. After an open distal clavicle excision is performed, clavicular and coracoid tunnels are created under arthroscopic visualization as previously described by Wolf and Pennington. The myotendinous end of a semitendinosus allograft is sutured to a Spider plate (Kinetikos Medical, San Diego, CA). The tendinous end of the graft is prepared with a running baseball stitch. A Nitinol wire with a loop end (Arthrex, Naples, FL) is used to pass 2 free FiberTape sutures (Arthrex) and the leading sutures from the tendinous end of the graft through the clavicular and coracoid tunnels, exiting out the anterior portal. One of the FiberTape sutures is retrieved with a grasper and passed over the anterior aspect of the distal clavicle. The second FiberTape suture and the allograft are passed over the distal end of the resected clavicle. While the acromioclavicular joint is held reduced, the FiberTape sutures are tied to the plate and the allograft is tensioned medially until the plate is embedded against the superior surface of the clavicle. The tendinous end of the graft is secured to the superior surface of the clavicle with a Bio-tenodesis screw (Arthrex) medial to the clavicular tunnel. PMID:17637416

Pennington, William T; Hergan, David J; Bartz, Brian A

2007-07-01

402

Arthroscopic Hip Labral Repair  

PubMed Central

Labral tears in the hip may cause painful clicking or locking of the hip, reduced range of motion, and disruption to sports and daily activities. The acetabular labrum aids stabilization of the hip joint, particularly during hip motion. The fibrocartilaginous structure extends the acetabular rim and provides a suction seal around the femoroacetabular interface. Treatment options for labral tears include debridement, repair, and reconstruction. Repair of the labrum has been shown to have better results than debridement. Labral refixation is achieved with sutures anchored into the acetabular rim. The acetabular rim is trimmed either to correct pincer impingement or to provide a bleeding bed to improve healing. Labral repair has shown excellent short-term to midterm outcomes and allows patients to return to activities and sports. Arthroscopic rim trimming and labral refixation comprise an effective treatment for labral tears with an underlying diagnosis of femoroacetabular impingement and are supported by the peer-reviewed literature. PMID:23875153

Philippon, Marc J.; Faucet, Scott C.; Briggs, Karen K.

2013-01-01

403

Arthroscopic Repairs of Triangular Fibrocartilage Complex Tears  

Microsoft Academic Search

Technical advancements in arthroscopic wrist procedures have improved our knowledge of normal and abnormal intraarticular wrist function. Triangular fibrocartilage complex (TFCC) tears from trauma injuries are a common source of ulnar-sided wrist pain. Fortunately, the TFCC is a structure that can be evaluated and treated arthroscopically with results that are comparable to open surgical procedures. Successful arthroscopic repairs of TFCC

Patricia Baehser-Griffith; John M. Bednar; A. Lee Osterman; Randall Culp

1997-01-01

404

Arthroscopic Posterior Stabilization of the Shoulder Using a Percutaneous Knotless Mattress Suture Technique.  

PubMed

Posterior shoulder instability is far less common than anterior instability, and its arthroscopic treatment can be technically demanding. We describe a percutaneous arthroscopic technique for posterior shoulder stabilization using mattress sutures and knotless anchors. Spinal needles are used to pass the sutures percutaneously in a mattress fashion. Knotless anchors are used to secure the sutures under the labrum. These anchors can be used without cannulas, giving easier access to the posterior glenoid. This procedure is simple, cost-effective, and safe, avoiding the presence of both knots and suture strands in contact with the humeral head. PMID:24749039

Tennent, Duncan; Concina, Chiara; Pearse, Eyiyemi

2014-02-01

405

Modified technique for arthroscopic Bankart repair using anchor sutures.  

PubMed

Bankart repair, or one of its modifications, is currently the gold standard procedure for treatment of anterior traumatic shoulder instability. It is now possible to perform the operation arthroscopically with the introduction of suture anchors. As described by Eugene Wolf, arthroscopic shoulder stabilization using the Mitek (Mitek Surgical Products, Ethicon, Edinburgh, U.K.) anchors requires two anterior portals and intra-articular knot tying. However, sliding the anchor on the inside limb of a suture loop could be challenging because the other limb could get tangled in the nitinol arc of the anchor. We describe a modification of the original technique to prevent that possibility and avoid any tension on the repair tissue during anchor passage. The proposed modification involves the use of a cheap, readily available silastic feeding tube to isolate the outside limb of the suture loop and stabilize labral tissues while the anchor is being passed. This tube also serves as a stent for knot tying. By allowing the whole operation to be performed through one anterior portal, the modified technique reduces possible morbidity associated with a second portal and further reduces cost. PMID:15243444

Saweeres, Emad S B; Thomas, Andrew P

2004-07-01

406

Arthroscopic Particulated Juvenile Cartilage Allograft Transplantation for the Treatment of Osteochondral Lesions of the Talus.  

PubMed

Several options exist for the treatment of osteochondral lesions of the talus. Particulated juvenile cartilage allograft transplantation (PJCAT) has become a viable treatment modality for osteochondral lesions of the talus that are not amenable to microfracture or for which microfracture has failed. Arthroscopic placement of this type of graft obviates the need for osteotomy or plafondplasty and does not prevent additional procedures from being performed through an anterior approach. Special instrumentation and setup are not required to perform this procedure. Our arthroscopic technique for placement of particulated juvenile cartilage into osteochondral lesions of the talus is described. Case series and outcomes after arthroscopic ankle PJCAT are currently not reported within the literature; however, it is believed that the outcomes are at least similar to those of open ankle PJCAT. PMID:25264516

Adams, Samuel B; Demetracopoulos, Constantine A; Parekh, Selene G; Easley, Mark E; Robbins, Justin

2014-08-01

407

Arthroscopic Particulated Juvenile Cartilage Allograft Transplantation for the Treatment of Osteochondral Lesions of the Talus  

PubMed Central

Several options exist for the treatment of osteochondral lesions of the talus. Particulated juvenile cartilage allograft transplantation (PJCAT) has become a viable treatment modality for osteochondral lesions of the talus that are not amenable to microfracture or for which microfracture has failed. Arthroscopic placement of this type of graft obviates the need for osteotomy or plafondplasty and does not prevent additional procedures from being performed through an anterior approach. Special instrumentation and setup are not required to perform this procedure. Our arthroscopic technique for placement of particulated juvenile cartilage into osteochondral lesions of the talus is described. Case series and outcomes after arthroscopic ankle PJCAT are currently not reported within the literature; however, it is believed that the outcomes are at least similar to those of open ankle PJCAT.

Adams, Samuel B.; Demetracopoulos, Constantine A.; Parekh, Selene G.; Easley, Mark E.; Robbins, Justin

2014-01-01

408

Arthroscopic proficiency: methods in evaluating competency  

PubMed Central

Background The current paradigm of arthroscopic training lacks objective evaluation of technical ability and its adequacy is concerning given the accelerating complexity of the field. To combat insufficiencies, emphasis is shifting towards skill acquisition outside the operating room and sophisticated assessment tools. We reviewed (1) the validity of cadaver and surgical simulation in arthroscopic training, (2) the role of psychomotor analysis and arthroscopic technical ability, (3) what validated assessment tools are available to evaluate technical competency, and (4) the quantification of arthroscopic proficiency. Methods The Medline and Embase databases were searched for published articles in the English literature pertaining to arthroscopic competence, arthroscopic assessment and evaluation and objective measures of arthroscopic technical skill. Abstracts were independently evaluated and exclusion criteria included articles outside the scope of knee and shoulder arthroscopy as well as original articles about specific therapies, outcomes and diagnoses leaving 52 articles citied in this review. Results Simulated arthroscopic environments exhibit high levels of internal validity and consistency for simple arthroscopic tasks, however the ability to transfer complex skills to the operating room has not yet been established. Instrument and force trajectory data can discriminate between technical ability for basic arthroscopic parameters and may serve as useful adjuncts to more comprehensive techniques. There is a need for arthroscopic assessment tools for standardized evaluation and objective feedback of technical skills, yet few comprehensive instruments exist, especially for the shoulder. Opinion on the required arthroscopic experience to obtain proficiency remains guarded and few governing bodies specify absolute quantities. Conclusions Further validation is required to demonstrate the transfer of complex arthroscopic skills from simulated environments to the operating room and provide objective parameters to base evaluation. There is a deficiency of validated assessment tools for technical competencies and little consensus of what constitutes a sufficient case volume within the arthroscopy community. PMID:23631421

2013-01-01

409

Arthroscopic debridement for dialysis shoulders  

Microsoft Academic Search

Purpose: To arthroscopically treat “dialysis shoulder,” severe shoulder pain in patients on long-term hemodialysis. This pain occurs only at rest such as during hemodialysis or while sleeping and is temporarily alleviated by assuming the sitting position or moving the shoulder joint. Limitations in range of motion and pain with overhead activity or the arm in the forward flexed position are

Koji Midorikawa; Masafumi Hara; Gen Emoto; Yozo Shibata; Masatoshi Naito

2001-01-01